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�fAPPLICATION FOR SANITATION PERMIT O <br /> (Complete in Duplicate) Iq <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---------------------1907-------------E----,-----1 2th-.------St--- re ------------------------------------------------------------------------------------ <br /> Owner's Name------------------------- - Paul R. Ronc_@.�/ Phone---��38D <br /> ----------- ------------------------- ------- <br /> 1907 <br /> th <br /> Address-----_------------------ ---------------------------------- <br /> Contractor's Name----------------------------------------------D-!--A-'----PARRISH &- SO�dS,----1HA-------------------- Phone----97!9b10_----------- <br /> Installation will serve: Residence)Q Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: L Number of bedrooms it] Number of baths n Lot size.... _5_'_x8 1 <br /> Water Supply: Public system JK] Community system ❑ Private ❑ <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [4 Hardpan ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) �\ <br /> t �) <br /> Septic Tank: Distance from nearest well�0��-----Distance famooGelation16s______��Mater��1__Ct---_L_`_---B�''.}.C�___��_______________.�O` <br /> No. of compartments = Capacity Size X --R6 ---Liquid depth---5V- --------------- V <br /> Cesspool: Distance from nearest well_________________Distance from foundation____-__-___-_______.Lining material-------------------------------------- <br /> ElSize: Diameter--------------------------------------Depth---------------------------------------------------- <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ <br /> El Distance to nearest lot line________________________________________________ <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------.Distance to nearest lot line____________-_---� <br /> ❑ Number of pits----------------------Lining material-----------------------Size: Diameter------------------------Depth--------_------------------------ <br /> Disposal Field: Distance from nearest°weH__ 3217C4�Disfance'from foundation_ _____________Distance to nearest lot line____ -_______ <br /> Number of lines---- <br /> Length of each line----?-5___-----------------Width of trench-----2' ___-__-_________ <br /> Type of filter materiai__Z.._.....B_-----Depth of filter maferiall-All-_- <br /> Remodeling and/or repairing (describe):______-__New Installation____� 'Loya__-Tr&ct -_______________ <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> 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) �.....A- F---A---R--R---I---S--H -- SONS--- IN-' Contractor) <br /> By:.--•-----------__-------------------•-----------------------------------------------------------•-------------------------------(T[fle)_E_S_t1rAator------------------ ---------------- <br /> (Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be filed with this application). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--------------- ___.__----_ ---_-----__ DATE______________4 -1 <br /> w <br /> f <br /> REVIEWED BY---------------------------------------------------- --------------------------------------------------------------------• DATE------ ----------------------------------------------- <br /> -- <br /> - <br /> BUILDING PERMIT ISSUED---------------•-------------------------------------------------------------------------------------- DATE---------------------------------------------------- <br /> Alterationsand/or recommendations------------------------------------------------------------------------------------------------•-•------------------------------------------------------ <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> -=---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------- -------------------------------- -- -- ---- -- ------- <br /> -----•------------------------------------------------------------- <br /> PERMIT No._ _ _ ______ ISSUED_-___ -__�' `7�---------- <br /> [Date} FINAL INSPECTION BY:----- <br /> Date-------------------- f------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> ES-9-2M 9-50 W4639 <br />