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APPLICATION FOR SANITATION PERMIT Permit No. <br /> i - ----------------------------------- - ----------------- (Complete in Duplicate) <br /> - s This Permit Ex ires 1 Year From Date Issued Data Issued <br /># strict for a permit to construct and install the work herein described. <br /> Application is hereby made to the San Joaquin Local Health Di <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION.__--- <br /> A --T ------------------------------ 0 ' <br /> d-- : _ -E- <br /> Owner's Name--------PH.J.LI-LP�----- .5 <br /> PQ ----___Q T-, !-�Q- ,` <br /> -- -- - <br /> f Address--:---------- r• - ��.k-_ �- <br /> - ,�/� r --- ------ ------------ ------------- Phone------ ----------------------------- <br /> THFOR <br /> Contractor's Name------------ �. ------------------------------------------------------------------------------------------- <br /> Q7�l�,!�_ <br /> ------ ---•---------------------- ------ P}Ione........ <br /> Installation will serve: Residence [r Apartment House ❑ Commercial ❑ Trailer Court (] Mote! <br /> All ❑ Other ❑ � <br /> Number of living units: -1----- Number of bedrooms _ .__ Number of baths�� <br /> Lot size -----g®----X-190 <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table J ft. <br /> Character of soil to a depth of 3 feet: Sand <br /> Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: (I€yes,date--------------- --) No ®—New Construction: Yes, No ❑ FHA/VA: Yes ' No ❑ <br /> TYPE OF.INSTALLATION•AND.SPECIFICATIONS: <br /> - ti�(Nb <br /> � =septic-ta-nk-or-cesspoo-l=p-er.mit-ted-if=public-ssewer-is ava-i�lab_le-within-200-f <br /> eet:)-,.�, <br /> Septic Tark: Distance from nearest well-�_ ® _Distance from foundation--. -:_ Mate-r-i�a-l---No.rof com artmen_ <br /> ts-_�` Liquid deppth _� <br /> R_te„ <br /> T - <br /> r-� ---- Ccity-- �----•Disposal • <br /> Field: Distance from nearest well C. W. Dis e from foundation - <br /> "` rm13 'o �,.... �' Distance to nearest lot I�ne�- <br /> Number of lines <br /> Type of filter material-_- - dCDe fih of filter material--.___117_ _-_----._Total length <br /> Seepage Pit: Distance to nearest well - - - i <br /> Distance from foundation ------_-_ tDistanceito nearest lot �ine-�_J----_-_.-- � � <br /> ❑ Number of pits------------------ Lining material-----------------.-----Size: Diameter___ <br /> -"�.-- Depth-:_ <br /> Cesspool: Distance from nearest well-----------------Distance from foundation ..__..- Lining material._-__- +-.__----_ <br /> - --------- <br /> ❑ Size: Diameter- Depth - '_ Liquid Capacity-'�7 _' " !--9al'. <br /> Privy: Distance from nearest well -- ( D stance from nearest buildin F>r <br /> -_ - - y --___'-•mow.. � --._ <br /> x �_�_, .w9 ---------------------------- <br /> --------------- <br /> ----------------- ---- <br /> El Distance to nearest lot line--------- _ -=��-�--�- -- <br /> - ----------------------------- <br /> Remodeling and/or repairing {describe):------------------ <br /> ----- - <br /> ---------------------------- <br /> -------------------------------------------- - ------------•------ ---------------- ---------------------­------- <br /> ------------------------ -- <br /> --------------------------------------------------------------------- - - <br /> - - ---------------------- �-----------%V6 kA 1 .3 31 ua Itt <br /> ------------- ---- - - <br /> F ------------------------------------------------------------ ---- ----------- -- <br /> Ihereby certify that I�have prepared this application and that the work will be done in accordance with San Joaquir .Counfy. <br /> ordinances, State laws, and,,rules and;regulations of`the San Joaquin Local Health District. <br /> (Signed)---------------- AJ <br /> ---------------------- ----- ---------------------------------- (Owner and/or Contractor) <br /> ----• __ _- r _ - _� I _ <br /> _ -----------. . - �,m_. ._=(Title} <br /> --I----- <br /> (Plot plan, showing size of lot, location of system_in relation to wells, buildings, etc., can be placed on reverse side}. <br /> r # <br /> t FOR DEPARTMENT USE ONLY <br /> J <br /> APPLICATION ACCEPTED BY----- --------- DATE-------- <br /> REVIEWED BY �r L(E J'-f <br /> BUILDING PERMIT_ISSUED = rt DATE --- <br /> = ---•------------ ----- DANE <br /> Alterations and or ecommendations:..._"._" _."__-' <br /> -- 13� -.4 �G �N,�s 4 I a ---------------------------------------------------- <br /> AW <br /> --- --=�'---- --- <br /> �� <br /> --------------------------------------------------- -------------- i --_-._--- _--------.-- <br /> - -----"-•---- �------------------------------------ f <br /> --_--•.---•-_.--_•--.-_•-------------------------------------"--. . <br /> - - ----------------------- -------------- ------------------------------------- ----- -- <br /> ' - <br /> } ---------------------------------------------------------------•_-.-----4t <br /> 1 � <br /> FINAL INSPECTION,6. '_/" Date '."1 .' <br /> t <br /> _ - A <br /> I SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> `1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street <br /> 205 West 9th Street <br /> Stockton,California Lodi, California Manteca,California Tracy,California <br />