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APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) <br /> Date Issued ____ <br /> Application 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 /> JOB ADDRESS AND LOCATION__---------460 Virgil---Ave-nue-------------------------------------------------------------------------------------------------------- <br /> Owner's NameCL1 - S Cook ---- - ---------------- Phone------------------------------------ <br /> Address----------- -------------Same as above <br /> . -------------------- -----------------------•_.--------------------------------------------------------------------------------- --------------------------------------------- <br /> Contractor's Name--_--Parrish__&__Sons-______ ________ _ __ ---__•_ HO 6-9607 <br /> Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel a Other ❑ <br /> 50 <br /> Number of living units: ___�__ Number of bedrooms 2- Number of baths ____� Lot size ______.�0��` <br /> Water Supply: Public system ❑ Community system ❑ Private ® Depth to Water Table ---451f. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe S Hardpan ❑ <br /> Previous Application Made: Yes ❑� No JK] 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--- ______Dista fro foundation____50.1____-- -.M . 1 cc cG brick f <br /> GG �t) 6 <br /> p] No. of compartments------------------- ------size-------_------�_-------------Liquid depth------- -----------------Capacity $OQ----------- <br /> i tt <br /> - - ----------- <br /> Disposal Field: Distance from near st well---60._._____Distance from foundation__..60-t__-___--.Distance to nearest lot line_._____-�-____ <br /> ® Number of lines:____= ---____________________Length of each line__30__3Q__20-__ZOidth of trench____ 411_____ i' <br /> Type of filter material-_�-`I'0 k----_-Depth of filter material_.__I8�-------__-_Total length---------- s <br /> t t 5t <br /> Seepage Pit: Distance to nearest well $ - ---------Distance from foundation---$__---------Distance to nearest lot line______ _________ <br /> ® Number of pits-------2------------Lining material------POGk___.Size: Diameter-_33- ------------Depth---.- 10 --- <br /> Cesspool: Distance from nearest well----------------- from foundation--------------------Lining material-----.__________--_-----_-_________- <br /> ❑ - Size: Diameter----•---------------------------------Depth-------------------- ------------- ----•----------Liquid Capacity----------------------------gals, <br /> ll <br /> Privy: Distance from nearest we ---------------------_-----____.__.__,._______-_Distance from nearest building______.,_____--__--------____________.__-_ <br /> ❑ Distance to nearest lot Iine---------------------------------------------- <br /> ---------------------------------------•-----•--------------------------------•------------ <br /> Remodeling and/or repairing (describe)--- ------ - -- - ------­­_------ -------------- ---•---------------------------------------•--------- -------------------------- <br /> ----------------------- <br /> -------•----------------- <br /> ---- ----------------------------------------------------------------------------------------- <br /> --------------------------- <br /> --------------•----------- <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 of the San Joaquin Local Health District. <br /> r � <br /> (Signed) Parra 5h & SOns r ________________(Owner and/or Contractor) <br /> By:-------------RUL-KrAght---'-------------------------------------- ----------------------------------------(Title)--------�S f---------------------- <br /> ------------ <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> t <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY - -- - ------- - --------------------------------------------- DATE---------------- ----- <br /> REVIEWED BY - - -` - ------------------------------------------------------- DATE �t <br /> --- --------------------------------- <br /> BUlLDING PERMIT ISSUED - - ---------------------------------I----------------------------- DATE------- <br /> ---------------- <br /> Alterations and/or recommendations:.----------------------- ------------------------•-----------------------------------------•-------------- <br /> -----=--f- ----------- n ----------------- ---------------- ------- ----------------------------------------- <br /> ----------- ----- --—------------------------------- ------- ------------------------------------------------------------------------------ <br /> -----•-----------------------------------------------------•- - <br /> - ----------------------------------------------------- <br /> -------------------------------------------- ------------- ----------------------------------------------------------- <br /> FINAL INSPECTION $Y:- --------------------- -------------- Date-----1_�... --------- ------(---------- --- ----------------------------- <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 /> ES-9---2M Revise6 1-57 F.P.CO- <br />