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APPLICATION FOR SANITATION PERMIT Permit No. <br /> l+ (Complete in Duplicate) <br /> Date Issued <br /> Applica#ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the wor erei descrF e <br /> This application is made in compliance �Orclinance No. 549. <br /> WindsFremont treet sembor <br /> JOB ADDRESS AND LOCATION-------- ,_- <br /> ------------- ----------------------------------------------------------------------------------------------------- <br /> Owner's Name---------SG2'V;L9q..S at ori_En ine rS ------ Phone------------------------------------ <br /> Address---------------------145f__:-..tree- -- Sacramento,-California <br /> Parrish Ina. ------------------------- Phone <br /> Contractors Name-------------------i h - c HO 6-�60 f <br /> ---------------------------- <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial KI Trailer Court ❑ Motel ❑ Other ❑ <br /> 2 tlets 200x200 <br /> Number of living units: -------- Number of bedrooms ________ Number of baths ________ �o size ___ <br /> Water Supply: Public system g Community system ❑ Private ❑ Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam ❑ Clay Loam [] Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ <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____-�Q_t___ Distance from foundation-----IQ--------- <br /> Material------ ----Ck------------------ <br /> EX No. of compartments-------3----------------Size----56---56--- 6-----Liquid depth__--------.--------_ pacityZ r '--- <br /> Ca r-�2 0 <br /> Disposal Field: Distance from neares�well____7�---___Distance from foundation___10_____----Distance to nearest lot ne___aa_____- <br /> [� Number of lines------------------- ----,_-----Length of each line---------30_. -____-__-Width of french.-- <br /> Type <br /> of filter material______ ek__----Depth of filter maferial_____�$5___-____Total length__-_________S_6/--___20_ ' <br /> Seepage Pit: Distance to nearest well---105----------Distance from foundation_-__.2_ __________DistaT+ce to nearest lot line__-_ _ ______ <br /> Number of its--_.__ <br /> - I� <br /> [� P -------------Lining material-----�'l�sr}L ---Size: Diameter------��-�-=:----Depth--- -. -25t-------------- R% <br /> Cesspool: Distance from nearest well________________Distance from foundation.-------------------Lining material-------------------___--___.________- m <br /> ❑ Size: Diameter------------------------- - -- -------Depth---------------------------------------------------Liquid Capacity--- -----------------------gals. <br /> Privy: Distance from nearest well____________________________________.______._.._Distance from nearest building----------_------------------------------- <br /> ❑ Distance to nearest lot line - ------------------------------------------ = <br /> Remodeling and/or repairing (des cr'be)-------------------- ---------------------------------••------------------- <br /> ------------------ - <br /> ------------------ <br /> ---- - --------- -- <br /> ------------�-,--�-y ,� <br /> �"l. <br /> ----------------------------------------------------•-----•------------------------- ------------------------------------------------------------------------------------------------------------------------------------- <br /> I hereby certify that I have prepared this app ication and that the work will be done in accordance with San Joaquin County ' <br /> ordinances. State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)----------- <br /> Parrish & SOriS ------------------------------------------------- --------------(Owner and/or Contractor) <br /> - a - <br /> BY:----------------------------Bill-- Wright--------------------------------- ------------------------------------(Title)---------ZB t---------------------------------------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> ----- <br /> APPLICATION ACCEPTED BY -- ----------WVV <br /> ------- ------ -- --------------------------------------- DATE <br /> REVIEWED BY - -------- ------------ DATE <br /> BUILDING PERMIT ISSUED------•---------------------- --------------------------------------------------------- DATE <br /> -------------------------------------- <br /> Alterations and/or recommendations:------------------------ ------------------- -------•-•--------------------------------- <br /> -------•---------------------•----------------------•-------------------------------- -------------------------------------------------------------------------------------------•-----------•----------------------- <br /> -------------------------------•------------------------------------ ---------------------------------------•-------------------------------------------------- ----------------------------------------------------- <br /> -----•----------------------------------------•-------------------------- --------------------------------------------------------- ----------------------------------------------------------- <br /> --------------------------------------------------------------------------------------- ------------------------------ ------------------•--------------------------------------------------------------------------- <br /> FINAL INSPECTION BY--------------- �/ sl <br /> -------- ---------------------------- Date---------1�=-j'`- -- -------------------------- ------------------------ <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 Lodi, California Manteca, California Tracy, California <br /> Revisea 1.57 F.P.CO. <br />