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,l 45 <br /> PPLICATION FOR SANITATION PERMIT Permit No. -_-----_O-0....... <br /> (Complete in Duplicate) <br /> Date Issued --57-_ ,T__-=�-j` <br /> Applicat; n is hereby-made.to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is"made in compliance with County Ordinance No. 549. <br /> KMX 6 So. <br /> JOB ADDRESS AND LOCATION------------------------------------------------- ---- --Carroll St, Stockton 3,5766 <br /> Owner's Name------ _-------•------ -- - Cora Burke Phone <br /> -------------------- <br /> Same <br /> Address----------------------------------------------------- ------------------------•---------------- <br /> Contractor's Name-------------­-------------------- - <br /> PARiISH--SI11C = ----------------- Phone-..-_.9-w60 ------------ <br /> Installation will serve: Residence PQ Apartment House ❑ Commercial [j Trailer Court ❑ Motel ❑ 12ther ❑ <br /> Number of living units: 2---- Number of bedrooms --_3- Number of baths -2__-. Lot size ------- ------------- <br /> Water Supply: Public system & Community system ❑ private E] Depth to Water Table �0-. ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe IN Hardpan ❑ <br /> Previous Application Made: Yes ❑ Nod] New Construction Yes ❑ No ❑ Supplementary Drainage <br /> TYPE OF INSTALLATION .AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well-----------------Distance from foundation------ <br /> oundatio------ P <br /> Material__-_-----._____----------_------.--_...___---: <br /> ExmSting No. of°compartments-- - -- -------- 1D e ' 51 <br /> ---------- <br /> t Size----- - - .. Liquid th- ------- --- - - ------ Capacity------- <br /> ----------- --- <br /> Disposal Field: Distance from newest wellla-.___---.-Distance from foun at' Distance to nearest IV e_ <br /> G <br /> 1 Expting Number of lines------------------ -- Length of each kin - I ---hake idth of tren h�_r-_---..-----_-_ oles <br /> Type of filter material___-_ 2--.._ k---Depth of filter materiaT_--i-------------local,len th-------_-----__--_-..--_--------__..---- ! <br /> t ? I V' <br /> Seepage Pit: Distance to nearest well100.-_.........Distanq@ roEmrf�ou dation-'--_____________3 Mance to neaeest o �ine-- _____------_ <br /> Number of pits. �" -Lining material((:: Brick Diameter Depth <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--. _ _ <br /> -__ ----.-----_.Lining material-----------------__ -.----------_-_- <br /> 4%❑ Size: Diameter-------------=-----------------------=Depth---------------------------------------------- ----Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest W'ell-------------------------------------------------Distance from nearest building------------------------------------------ <br /> ❑ Distance to nearest lot Iine.------------------------------------------------------------------------------------------------------------- ---------- ------------ <br /> Remodeling and/or repairing (describe)---------------------- -----------------------------------------------•------•-------------------•--------•----•----------------------------------------- <br /> F•--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------ <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations ofd San Joaquin cal Health District. <br /> Si nedh. PARRISHNC. _ ( � � Contractor) <br /> - <br /> tx <br /> ( g }------------------------- Estimator ' <br /> ------- <br /> By:-------------------------------------------------------------------- - <br /> 1 = (Title) <br /> (Plot plan, showing size of lot, location of system in elation to wells, ildings, etc., can be placed on reverse side). <br /> OR-DEPARTMENT USE ONLY <br /> APPLICATION AC <br /> CEPTIrD i3Y -- DATES _-- <br /> -= - -------------n_ ------------------------------------------------ ,.�� <br /> REVIEWED BY------------------------------ DATE V%V.1--- <br /> - - - -------------------------------------------- <br /> BUILDINGPERMIT ISSUED----------- . -- ------------------------------------------------ DATE-------- ;�;---------------------------------------------- <br /> Alterationsand/or recommendations------------------------------- --------------- --------------------------------------------------------------0'----------------------------------•--••- <br /> --------------- ------•-----------------I---:-------------------------------------...------------------------------------------------------------------------------------------------ -------------------------------------- <br /> -» = -= - --------------- -------------------------- ------- -------------------------------------------- <br /> --------------- ---- ----- <br /> FINAL INSPECTION BY:..------- V / -------- Date-- ------------✓_--7— -- --------------------------------------------- <br /> SAN JOAQUIN LOCAL'HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California 4 Lodi, California Manteca, California Tracy, California <br /> ES-4-2M 0-52 Ravised W:2100 <br />