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i ..._....__ y� A'-ICATION FOR SANITATION PERI L�i'Permit No. .../... <br /> ---'--"-•-•--- . i...... .............. (Complete in Duplicate) � '!.� i D �O/ 1 <br /> ar <br /> m Date <br /> Applfcatio s,heseby�r��de to the San Joaquin Loca Healfh District foroa permit to construct and install work herein described. <br /> !/ <br /> ..... . .... ........ <br /> p <br /> see This applicion is made'in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION-- - - ------ .�___RF F. ........ .. ..:.........1L .1--- .�ZJ.Ez....--•'- - <br /> '� Owner's Name.---....V.L-c.TQ --------13. R.f�.4.....`........... ..'-...... -...---..:... - --.......... PhoneC,[Q.... <br /> Address........ -.".�...:.' 3ox-------_-178..(p--------� . ._.HR.Qn_.....- - ...................................................................... <br /> Contractor's Name-------- ��.--------------------------- .. . ......................................- - -....................... Phone................... -'-'--'- <br /> _ <br /> Installation will serval` Residence 0 Apartment HouseeCommercial ❑ Trailer Court her <br /> Number oj4iving units: .a.... Number of badro s .�.. Number o bo#hs Lot size .._ . J>44.F ... ........... . � <br /> Water Supply: Public system ❑ Community sys ❑ Private Number <br /> to Water Table .. ... ft. --�� <br /> Character of it to a depth of 3 feet: SandI Gravel [ISandy Loam ❑ Clay Loam ❑ ay❑ Adobe E] Hardpan ❑T/ <br /> Previous App ication Made: )If yes,date....._1. ........-) No �New Construction: Yes No ❑ PHA/VA: Yes ❑ No L� <br /> TYPE OF IJSTALLATION AND SPECl/ftdlif <br /> IONS: <br /> (No I eptic tank or cesspool permipublic sewer is available within 200 feet.) <br /> Septic anti: Distance from nears +l.7 � ._.Distanse/from foundation...���.._...Ma�riaL_ _ �wOD.._......._. <br /> El No. of compartmen s- -----.i -._.._..Size./!}_.q.1a X..,S.._....Liquid depth....... ...---... --------Capacity._��-.�..�.._.. <br /> Disposal FId: Distance fr m neare t well...3.Q.'O_.Distance from foundation..../0 Distance to nearest lot line...... tr <br /> `. JJJ Number of�iss. ._. ........_..._._....._..Length of each line..:: QWidth of french.-JA... ........_ .T: <br /> Type of filterhia al---- 0Cn._Depth of filter materiaLJ.#. ...7,__..Total length-------.. .. _ ..._..../ <br /> Seepageif: Distance to nearest well......................Distance from foundation..3()........Distance to nearest lot line............ <br /> _ ❑ tt Number of pits------- --------------Lining material---------------------..Size: Diameter.......................Depth.........--------..._.------..._. <br /> Cesspoo: Distance from nee st well-----------------Distance from foundation........------------Lining material_.................................... <br /> ❑ Size: Diameter....... ............ . - ......Depth. ....................._.._..._........'----._.....Liquid Capacity......'-------------._..gals. <br /> see Privy: Distance from near tsf well.................................................Distance from nearest building-----..-------- ----------------------- . <br /> ❑ ) Distance to nearestlot line...................................................................................._...... ............................................. <br /> RemodIing and/or repairing (describe :--------------------------------------------......................................_...............'-......................-'---'----- <br /> -......--- - - ............. _........-...------...........__..._.......------.*----------------- <br /> '----- <br /> . <br /> - - -- --------- - .._..-------------------­ .............. <br /> ------------i_...--------------- --- -------- -- ----- <br /> I hereby certify that I have prepar d this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, to a laws, and rules and r gulations of the San Joaquin Local Health District. <br /> (Signed} --- -' - - ....._.............(Owner end/or Contractor] <br /> Ily:-------------------_-------------------- ----_------------------------- ... . .. Title <br /> - --- ' ....... -- ...... .........__....- ....... <br /> (Plot pl4n, showing size of lot, Iota} fern in relation to wells, buildings, etc., can be placed on reverse side). <br /> r FOR DEPARTMENT USE ONLY <br /> APPLI ATION ACCEPTED BY.... ........__..... - .................. DATE------ ..'3...0..- ............._._... <br /> REVIEWEDBY.......................................... .----------------- ------------.....------------------------------------- DATE-------------------------------------------...------------ <br /> BUILDI G PERMIT ISSUED..................... -' -_ ..........._........-- ---'-- . ........................... DATE--- <br /> Alterati ns and/or recommendations:..... ...........- ..._......._.................'...................-----... -- ........ ... ..........--' - .. . -- ---.......... ' <br /> ..._........ ..................................................... <br /> .......... _. ............................... - ....... ....... ..... .. a ----------- <br /> *......................... <br /> .................... <br /> ...------- <br /> -- ------- <br /> ------.. <br /> r....... .... ._.. .. . _ ...-._.........................._......_............._.. . .._...._.. <br /> --------------------- <br /> .............. <br /> ............. ...................... ..... <br /> _..._....._ .. .. ..... ...�.._, ..... ... .......................................................... <br /> FINAL INS <br /> _. .. ..._ . ------------... -.------.__..........-..... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> see 130 south Amerimn Shut 300 Wert Oak Street 124 Symmers Street 205 Wert 91h Stns <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ce s vevivco a-ev r.v.eo.a.,s-sa <br />