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FC0,R OFFICE USE. Permit No. <br /> ................... RMIT <br /> ...........0 <br /> ......... -APPLICATION FOP, SANITATION P' <br /> . . ..... plate in'Dupliczitel Date issued <br /> .............--......................... (Clorn <br /> ........ ....... jr From Date Issued 0 1.5-0 -1 <br /> ...... This Permit Ex ires, 1 Y02 described. <br /> ris,,, ct and install the work here. <br /> is hereby made to 'the San Joaquin Local Health Distric'for 6 Permit to co ir <br /> Application w*,tb County Ordinance No. 549, <br /> ica4-ion is made in Compliance X4- <br /> -this appi 94-- S—W. --Itpuezole� <br /> OCATiO <br /> JOB ADDRESS AN? L -Z- ------ .... .. . . .... ........ Phone,..........----—---- <br /> ........................ <br /> Owner's <br /> -7..... Pho a -7 <br /> Address ........... n <br /> A <br /> Contractor's Name............. <br /> In Ap-artment House C3 COMmOrclal Trailer Court F1 Motel C] 0 .......... <br /> .stallation will serve- Residence D ' bedrooms _-... Number of baths --- Lot size ............................-... ------ <br /> Number of living units: ._-- Number of Water Table ......- ft- <br /> Supply- Public system C3 Community system [I private [D Depth to be rj HardPart 0 <br /> Wa+ar depth of 3 feet: Sand 0 Gravel 0 Sandy I-oam 0 Clay Loam 0 Clay C] Ado <br /> Character of so4l to 8 -) No C] New Construction: Yes 0 'NO FHA/VA: yes No [I <br /> Previous Application Made, (if yes,dote.-.... ........ <br /> TyPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is availa6le within 200 feet-) Material....—--------- .. ...... ...... <br /> Septic Tank- Distance from nearesir well......----Distance from foundation.......- ......... <br /> -, 04 compartments.--,- Size......... deP'th--- <br /> N, nJ4 it lot <br /> ll,.5. . ......Distance from �oundai;o istance to rteare <br /> Disposal Field: Distance from nearest we . . .....-. .Lerigt1hi of each 1*-ne-... of trench- .......... <br /> ur �h <br /> mloer of lines. <br /> N ...... ienql <br /> AC -41 <br /> _Dptr, oj [l fer material- <br /> Type oi 4ilfer mA— a to nearest lot line...... <br /> est well_ <br /> D',itar.ce to neeir .-Distarite from f0unciat�or- Depth....... <br /> Seepage pli, aferial---......... Diameter... <br /> Number of P;ts.-...., Uning m <br /> Cl irom foundation......--.......- ---------- <br /> 0*earice ti-om nearest weil--.- -Distance quid Capacity......---...... <br /> .......-Depth......--........ ............. U <br /> Slie: Diameter- --.............-... .-Ditance from nearest builciing-­14-1. .......... ...... <br /> Privy. Distonce from nearest well...... ........... <br /> Distance to nea-est 1 4- line --------------------- <br /> rep iring (describe):- .................--......... <br /> Remodeling and/or a ...... ........... <br /> ---------- ......... .............................. ....................... ........................ . <br /> ................ <br /> ............-,------------------- --------......--.. .... ...... <br /> 11 big done in accordance v4A San Joaquin County <br /> repared this apprication and +hat the work wi <br /> I hereby certify that I have P s of the San Joaquin Local Health District. <br /> ordinances, to l&ws,.an8 rules d regulatlon <br /> ---lOwner and/o�-C;74 <br /> ........... is <br /> By .......... -------- r 't elis, buildings. etc., can be p <br /> jj%$ of lot, location of system in r atiOn to w <br /> (plot Plan, showing <br /> FOR DEPARTMENT USE ONLY <br /> D ATE-A-.2---t <br /> ........... -------- <br /> APPLICATION ACCEPTED BY ....... .......1. - <br /> DATE� ...... <br /> .......--............ ....... DAvTE........... ............................ <br /> REVIEWED By, ...... <br /> BUILDiNG PERMIT ISSUED�......... ------------------- ------- ....................... <br /> 0 Alterations and/or recommendations-- ... ... i"�A'11....... ........ ........ <br /> ....................................... .......... ......—­-- . <br /> .......... ...................................11.............. ................. ......... <br /> ............... ....................... . ........... ....... <br /> ........... <br /> .............. ......... ........ .............. <br /> .......... <br /> Date., �....... <br /> FINAL INSPECTION By:-- <br /> . SAN JOAQUIN LOCAL HEALTH DISTRICT 205 West 9th skre*t <br /> Scyoifon Ave. 300 West 004,Street 124 Sytam*ylb street Traty,Califormia <br /> Lodi,California mamt"*,California <br />