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FOR OFFICE USE: <br /> �7G <br /> iso APPLICATION FOR SANITATION PERMIT <br /> �= 7)-is <br /> ---------------- <br /> Permit No. _____________________. <br /> ,�,' f -'� .(Complete in Triplicate} <br /> -____________ This Permit Expires 1 Year From Date Issued Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION -------------------- X-------23-_North Oro-Ave.__S .OcktOn-._. CENSUS TRACT ------------------------ <br /> Owner's <br /> _.___________.______.Owner's Name -------.---------- }vlar' �B Ward I —01n <br /> .: .4 ' <br /> - _._. ...�,:----�-------------- ----------- --- hone._ 13.72 <br /> Address --------- --------------------- ---- 2 __Ngrt4.Oro Av r Stockton 1 <br /> CitY -=--------------------�- -------- <br /> Contractor's Name --------------------L1.A.-_ 'AJC'r_x h_.& Sotltl-s-- n�-•--- --------.License # ------1P0511---- Phone -----hO69.6Q7---------- <br /> Installation will serve: Residence M-Apartment=House.-E,,( ommercial:❑Trailer Court <br /> Motel ❑Other <br /> Number of living units:_-___Z____ Number of bedrooms __`�__¢'_0Garb`age Grinder ___ o___ Lot Size --------�9.x_185_ <br /> ' i <br /> Water Supply: Public System and name --------- --- - ----------------------- `------------------------------ --'---------------------------Private ] <br /> Character of soil to a depth of 3 feet: Sand'[:] Silt❑ Clay ® JPeat❑ Sandy Loam -❑ Clay Loam ❑ <br /> - S��+•..... _:.. .....,..... <br /> Hardpan E] Adobe. Fill Material _____ If yes,Mtype ___________________________ <br /> (Piot plan, showing size of lot, location of system in relation to wells,',buildings, etc. must be placed on reverse side.) <br /> e. <br /> NEW INSTALLATION: (No septic tank or seepage{pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT kJ SEPTIC TANK [x] Size------8x5xJy_�__-ti_! ---------- `___ Liquid Depth ___5211_ <br /> -------------- <br /> Capacity -----12{X3_------tType.---PT'BCast_ Material-----concrete No. Compartments -__2---------------- <br /> I ' <br /> Distance to nearest: Well 1'___ 31one_______________________Foundation ----10, Prop. Line ______$_,_-___-_____ <br /> LEACHING LINE [ ] No: of Lines ---ane_-_(1_)____t-Length of each line---lOP�­4�--------- Total Length ___lati1________________ <br /> D' Box ____________ Typea r-Filter Material _.1 Depth Filter Material- ______191--------________________________ <br /> r c <br /> Distance to nearest: Well None.____________ <Fodndation ____],Z1._.____-r <br /> ` #Property Line_ - S�__..... <br /> -01 <br /> SEEPAGE PIT [ ] Depth ___25------------ Diameter "_x_3.6«"_ Number --------(1)------.___i--- Rock Filled Yes :E] No i❑ <br /> Water Table Depth ------45r------------------........ -------Rock Size ---IAWA----------------- <br /> Distance to nearest: Well -------name----------------- <br /> R_______Foundation '_ ____+_____ Prop. Line ____ '______________ <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------_------------------------- ---- Date -------------------- __-__-___-___) <br /> Septic Tank (Specify Requirements) ----------------------- ---------------------------------------------------------------.'---------------------- • ) <br /> Disposal Field (Specify Requirements) ------_t----_ r i <br /> -------------------------------------------------- --_ _ <br /> ------------------------------------------------ <br /> � <br /> -------------------------------------------------------------- ----------------------------------------- ------------ <br /> S <br /> A <br /> (Draw existing and required-addition'on reverse side) t <br /> I hereby certify that 1 have prepared this application and that ithe work will be done in accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of,the:-San Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the following: <br /> t <br /> "I certify that in the performance of the work for which this permit is issued, ,shall not employ any,person in-such manner <br /> as to become subject to Workman's Co i:nsation laws of California." .► ow <br /> Signed ,_Parrish $` : '...�-- ---".-'...'--".--"��w?ner m t <br /> BY a ��- -------------------- ---------- -Titlez <br /> - <br /> {If other than owne s # <br /> FOR .DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY - Yf--;_✓9------------------------------------------------------ DATE `---------'-----7-6---- <br /> BUILDING PERMIT ISSUED --------- ------------------------- ----- - ---------------------------------------DATE ------- <br /> --------------------------- <br /> ADDITIONAL COMMENTS __________ ______ __ <br /> ---- --- <br /> ----------- ------------------ ---- ------------------------- -------- - <br /> - ---------- <br /> -------------------- ---------------- - ------------------------------------------------------------------------------------------------------ ---- ----- <br /> ----------------------------- <br /> - _ ' <br /> Final Inspection by- - ----------------------------- <br /> --------------------- - ------ ------------------------ Date �� <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />