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FOR 4FICE USE: -------- <br /> ------------------- <br /> '"� <br /> APPLICATION FOR SANITATION PERMIT FOR OFFICk U 6 <br /> 1`11�— (Complete in Triplicate) Permit <br /> ... .................`.. This Permit Expires 1 Year From Date Issued Date Issued -- � <br /> Application is hereby made tomhe San J with <br /> C `Local.Health District for a pelf it to construct and install the work herein described. <br /> This application is made in compliance with County,Ordinance No. 549 and .existing Rules and Regulations: <br /> �4 JOB ADDRESS/LOCATION <br /> ....' .�?_.... .�...1..�r. �.....u...c•k---a�-.-.x-l-�--....... .D...O..D /fff` - <br /> u '= S <br /> ...r�Stt <br /> .... TRACT.. <br /> T......-...--.:....Owner's Name.- c .. <br /> --�- ...... <br /> Frem , t_ St. <br /> Address... 204.__7.4_1_­..__..__,Phone.. <br /> . . E ---.City -Stoc.kt.on <br /> Contractor's Name.-._PARRISH, INC. .. ..... -zip`-952.05----------- <br /> ... ..... . ..... ..... . ...License #- 100511 Phone. 66 '3_$31 ~ <br /> -Installation will serve; Residencep . <br /> ❑ A artment House ❑ Commercial� Traile_r Court ❑ • <br /> Motel ❑ Other__..-------._- E <br /> System ��. <br /> _.... �'--•-------..Lot Size---•--....-�-- <br /> um <br /> Number of living units:..-,—- <br /> -----...... .Number of bedrooms....._. <br /> ..._..._.. .........:..... <br /> Water Supply: Public 5 stem and name._-..-Private _ , <br /> ---_.----Garbage nndl . <br /> ...----.-Private <br /> Character of soil to a depth of 3 feet: Sand ❑ Silty] Clay f3 Peat 0 Sand; <br /> Loam <br /> Hardpan Y ❑. Clay Loam ❑ <br /> P ❑ Adobe ❑ Fill Material _ .._ � :.�• • <br /> If.yes, type.... -----.---- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc.-must be placed on reverse side•) <br /> NEW INSTALLATION: (No septic tank or seepage <br /> pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT f ] SEPTIC TANK , t g t .g 32 t <br /> ] Size....._. ..... . . � high _-___ .Liquid Depth............. <br /> - 7',,. <br /> 800 al. Yp ----- .. a <br /> Capacity ...... ..... .....� e -.._....__-.,,. Mate�rial_COncrete No. Compartments..-- <br /> ----_---------- ------------- <br /> Distance to nearest: Well------ t <br /> ..•--- __.Foundation.....6:Q Prop. Line 23Q!.............p <br /> LEACHING LINE <br /> (x] No, of Lines... -1-------- ---------Length of each fins------ <br /> - <br /> ------------- Total Length .. ...... �y <br /> 1. <br /> D' Box..._. _...Type Filter Material. _Ra�k......Depth Filter M6terial...._2C-��__.. <br /> Distance to nearest: Well...1'060 F_._.. --_._,Foundation..60 .._...- <br /> GE PIT "� <br /> t rr ---.------Property Line......2.�0 fi_ <br /> 1 Qepth .�..- Qiameter. .. ---- --.Number..... r ----- <br /> EPARock Filled Yes ❑ No <br /> Water Table Depth...... _&.'-...- o- <br /> - - --------Rock Size-- <br /> Distance to nearest; Well,.,fld� —... _Foundation 4.... _ <br /> - - -- .....---• �..�. ...._..Pro Line..- ; <br /> p 2!_ <br /> REPAIR/ADDITION (Prev. Sanitation Permit#...-...��A--.•--,-.- � <br /> ------- - ---------------date--------�-•--- ---- � <br /> Septic Tank (Specify Requiren,ents).t.... .................... <br /> Disposal Field (Specify Requirements)....... <br /> ----------- <br /> ------------------- -- <br /> (Draw existing and required addition on reverse side) <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 of the San Joaquin Local- Health District. Home owner or licensed agents <br /> signature certifies the following: ! <br /> "I certify that in- he performance of the work for which this <br /> permit is issued, t shall not employ any person in such manner as <br /> to become su je to Workman's mpensa i laws f California." <br /> Signed........ - -- ��C'... -- - ..- r <br /> - ----- ....Owner , <br /> By. --- -~-� .... . Ti 1 <br /> tle ------- �.... ! <br /> Of other than caner) - <br /> ---- ----- ----- ---- <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY..... .. <br /> - DATE <br /> DIVISION OF LAND NUMBER . <br /> . :. -- - --- <br /> ------DATE <br /> ADDITIONAL COMMENTS--..-,-. ... .... .... <br /> . .............. .............. . <br /> ... ------- <br /> ............. --------- ----- -- -------- <br /> ..... <br /> -------- <br /> ---------- <br /> ------------- -------- <br /> Fina Inspection 6y:...._.. <br /> EH 13 24 <br /> Ess 677 REV. 7/76 3M <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT pis <br />