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`. <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> 1 <br /> (Complete in Duplicate) <br /> ! O <br /> Date Issued ff l <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work-herein described. <br /> J This application is made in compliance with County Ordinance No. 549, <br /> 1020 South Broadway <br /> JOBADDRESS AND LOCATION----------------------------------- ------------------------------------------------------- ----------------------------------------------------------- ------- <br /> Owner's Name-------------------xar-Old---CUS1. d&B----------- HO 2-3863 <br /> ----••----------------------- - - --- ------------------ -- --- Phone <br /> --- .----------•--------------- --•---- <br /> Address_---------•-------------------Same -a_s above <br /> ------------------------------------------------------------------------------------------------------ - .. <br /> Parrish Inc HO b-9647 <br /> IContractor's Name------------------•------------------------------- -------------------------------------------------------- ---- -- ------ Phone-----------•----------------------- <br /> Installation will serve: Residence IR Apartment House ❑ Commercial ❑ Trailer Court [I Motel ❑ Other [] <br /> Number of living units: ___1_ Number of bedrooms ----- Number of baths ____% Lot size '_____�OX120 <br /> Water Supply: Public system n Community system ❑ Private ❑ Depth to Water Table <br /> iCharacter of soil to a depth of 3 fee+: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [� Hardpan ❑ <br /> Previous Application Made: Yes ❑ No [1, 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 /> alk: Distance from nearest well-________________Distance from foundation-___.________.____.Material------------------------------------------------- <br /> g No. of compartments--------------------- ----Size-------------------------------Liquid depth--------------------------Capacity----------------------- <br /> i� i Distance from nearest.well._.NgnG___Distance from foundation___20; Distance to nearest lotel�___ r______. <br /> Number of lines_________i--------------- Length of each line_______34f_ ' Width of trench.__.________ _ <br /> rrt �t- --- - - <br /> Type of filter material__________rflCkDepth of filter material----_--Z�_ _._____Total length________3__________________________ <br /> Seepage Pit: Distance to nearest well-None---------Distance from foundation---20_r_--------Distarjrte to nearest Io 1i 51 <br /> ® Number of pits_----__1..__________Lining material-______r�Pk_-Size: Diameter_______33___-____Deptn___._.__. _________________ <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material__:_-___________ _______- <br /> ❑ Size. Diameter---------------------------------------Depth--------------------- ------------------- ---------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well------------------------------------------------- from nearest building------------------------------------------ <br /> El <br /> Distance to nearest lot lire-------------------------------------------------------------------------------------- <br /> Remodeling and/or repairing (describe)--------- ---------------------------------------------------------------- ---------------------------------------------------------------- ------ <br /> -----------------------------------------------------------------------­------------•----------------------------------------------------------- ----------•-------------------------------- <br /> ------------------------------------r---------------------------------------------------------------------------------------------------------------------------------------•-----------------------•------------------------ <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. <br /> (Signed)----------------- - ---------Parrish-----------Inc-------:--------------------------------------- - ----------------------------------------------------------�'S(Owner and/or Contractor) <br /> Bill Wright <br /> By:------------- -•------------------------------------------------------------------------------------------------------------------(Title)---------------,---------------------------------------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> f FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------------------------------------------------------------------------------------------------ DATE----------- / ---------------------- <br /> - - --------- <br /> REVIEWED BY---------------------------------------- -----------t- -- ----- - <br /> - - ------------ --- <br /> ------ DATE---------�� --- ----- <br /> BUILDING PERMIT ISSUED------------------ ----------- -- ----------------- --------------------------------- DATE <br /> Alterations and/or recommendations:-- --- - --------------------------------------------- <br /> ------------------ <br /> I <br /> X-3 +� -----------------------------------------------------------------------------------------------------------•--- <br /> _ x – -- <br /> J/ <br /> FINAL INSPECTION BY: 'D_7C------------------------------ ------------ Date -� ' -------------------------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> g 130 South American Street 300 West Oak Street 132 Sycamore Sfree+ 814 North "C" Street <br /> k , Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M , Revised 1.57 F.P.CO. 1 <br />