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, r ' <br /> K o- <br /> FOR OFFICE U$E: <br /> .. ....... .. A6/ G:�:.:.. ,(/ alt <br /> •-...... ......-•• .................. ........ APPLICATION FOR SANITATION PERMIT Permit No. <br /> .......................................................... (Complete in Duplicate) <br /> - - - This Permit Expires 1 Year From Date Issued Date Issued __ .. <br /> q •... n ...s -.. •permit to construct and install the work 'bed: i <br /> Application is hereby made to the Sen Joaquin Local Health District for e <br /> This application is meds in complie ,s,,,rwrith�C[oun/yJ�Or�dina�nceQNo. 542. <br /> JOB ADDRESS ASND/kOCATIOZ91 ,.p �%�("...:�"'.. f, y� <br /> Owners.Name..GCY.���'4• ?Y..i2�r............................................ . <br /> . ...._`.......__. <br /> Address.:.. r <br /> d. .p.. .Ra.... <br /> Contractor's Name.. r. ,�,�! ..{ a.•.e�iT.._V...T....v1-:ll.G.rs............................... Phonan&4f 7_.._..�t � <br /> Number <br /> serve• Residence ff rfperfinent House ❑ Commercial ❑ Trailer Court ❑nM'ot i ❑ Other ❑ <br /> Installation ,f Irving units:.. . Number of bedrooms_7-y.. Number of baths ./.. Lot size ..frf�C�.Gt...... 0' ' <br /> Water Supply: Public system )] Community system ❑ Priveteb<'Depth to Water Table ex t. xL\ <br /> Character <br /> a � feet: ❑ Gr've ❑ Saeearn[] <br /> ls I ❑ <br /> Previous Application Made: ( ysdtNwCnsct on: Ye ❑ No ❑ FHA/VA Yess❑ No❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS:1<2 <br /> (Noseptic tank or cutspeof permitted If public sewer is available within 200 foot.) r <br /> is T t Distance from nearest well..............Distance from foundation......... Material..........._.............. <br /> pt <br /> �.,No, of compartments................. ..Size................................Liquid depth ................ Capacity ..... ... <br /> r) <br /> s el . :Distance from nearest well,�.Q6 _Distance from foundefwn._lsor7 '.'..Dahanes to nearest lot line- <br /> Number <br /> ne Number of lines.. .......... Length of each lir 2Z........ <br /> - � : fr ....../ �....Tofalength of filter Depth of ... . ._.... v <br /> ; <br /> Seeps a Pit: Distance to nee?est well 1 .Dislencp from urS,J..pPfion.._.�j�r ...Distance to nearest lot Ime..... <br /> Number of adf... / Lmmg material �11. 1....Size: Diameter _ �,3!.. Depth . „��.... . ` <br /> Cesspool: Distance from oeerast well.................Distance from �nd6t'on <br /> ................Lining material.... w+ <br /> ❑ Size: Diemetor._.. ..... Depth ..... .............................Liquid Capacity ... gels. <br /> Pnry: Distance from nearest well.... ................ .._.Distance from nearest building............ <br /> S ❑ - t y Distance to nearest lot line................ .... .._..............._......).. ..._._......... ...................... <br /> ... _._... <br /> Remodeling and/or repairing (describe) ... ) , <br /> ...... <br /> . <br /> .. ..... .. .. .. .. ...:.. I .... iE_. _ <br /> I hereby certify that I have prepared th;s.appPsoetion and that f e work will be dons an accordanw with San Joaquin Coun <br /> ordinances,.Sfet S, aanmules and rrejg%ulation of the 5 Joa cin ealth District. <br /> i ! - <br /> : ..: ($igned)�. "i /l.si. .. .......... Confia�ror) <br /> By:.... :....:. .. ...... (rifle) <br /> (Plot plan showing sizeoflot, location of system in relation To , Oldings, a ., can be placed on reverse side). <br /> FOR DEPA MENT USE ONLY. ; <br /> r' APPLICATION ACCEPTED BY....... .._ :K! ............................ DATE L/ ...67....Z.1 <br /> °Pp REVIEWED BY__(._. ... . ...... .. ../ .. ......... DATE.................._ .. _... ......._....... <br /> ' BUILDING PERMIT ISSUED.........................L.....__..............___....._­.'..­.".".'.­.'.­ <br /> Alterations <br /> ..........:......................_... DATE.............................................__:_........AltareTion - .. ..�... ... ^ am '7 <br /> and/or r9com endatiom: '1"�� `J .......+...Y .. 9�.�....�.�...�.�.a�....t... I <br /> . .. ..................... `. <br /> _... ... .................... .................................................................................................._........ -. <br /> ..... .... .... . .......... ... .................................................................................................................... <br /> FINAL INSPECTION BY V .O.-c: -r.. te �f 2- <br /> (� ........... Deis...... . .....- . CP Z <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> t.10 feud,A,nerimn Preer 700 west Oak sinal 124 Srceinen f1rM1 205 west ala 51,90 <br /> fvackven,ee1110mic W1,eallrernla Manbra,Cellfsmle Treey,0.11Nmie <br /> :e � n v uvuro v�w ew e•n erw <br /> 1 <br />