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APPLICATION FOR SANITATION PERMJT Permit No. <br /> (Complete in Duplicate) <br /> Cl(-T o Date Issued /P-- ----- -- <br /> Application is hereby made to the.San Joaquin Gcal 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 /> Stockton <br /> JOB ADDR5SS AND LOCATION--------------=---&__ --------------------------- --------------------------------------------------------------- - <br /> Owner's Name--------------------------------__----------traunan-E-C-Gill--------------------------------------------------------------------- PhoneY-7? 5-----------_---- e. <br /> Address---------------------------------------------------------3_5_5 Mourfield Ave. - -------------------------------------------- <br /> _9 ----------------- Ave. ------- <br /> Contractor's Name--------------------------------------PARRI-Sh----INC------------------------------------------------------------------------ Phone-9-X00--607----------------- <br /> Installation <br /> hone-9-0/697----------------- <br /> Installation will serve: Residence)% Apartment House [] Commercial E] Trailer Court E] Motel E] Other Ll <br /> Number of living units. --I--- Number of bedrooms -2---- Number of baths J-______ Lot size -----6-0-1----X------150,----------------------- <br /> Wafer Supply: Public system E] Community system 0 Private [Z Depth to Water Table 3Q,ff. <br /> Character of soil to a depth of 3 feet: Sand F-1 Gravel 0 Sandy Loam Ej Clay Loam E] Clay E] AdobeX] Hardpan E] <br /> Previous Application Made: Yes E] No E] New Construction: Yes 0 No 0 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> ri <br /> Septic Tank: Distance from nearest well----601------Distance from foundation----15---------Material---C-----C---B--------------ck <br /> ------------------------ <br /> xx No. of compartments-------2-----------------Size----561,X3 61,---------Liquid depth-----52-1-1--------------Capacify�QQ_qa_l--- <br /> 1 11 d qe -------3-0-1-----Distance to nearest lot line___5 t---------- <br /> Disposal Field: Distance from nearest well____-7_0-------bisfa&from Tdafion <br /> xx Number of lines-------I------------------------Length of each line-_3-Q1-----------------_-Width of french-------24"------------ <br /> Type of filter material-__l 7ff'-1'----Rk----Depth of filter material-----18 .......... <br /> -------- -Total .length-- -._.3g.,--------------------------- <br /> Seepage Pit: Distance to nearest well---100' -Dista-ac,-from fion- .100, ...Distance to nearest f iine_51--------- LO <br /> -------- , I <br /> k 0 <br /> (�ksi �iarneter--- ---------------Depth-----1�-------------------------- (R <br /> Number of pits------ =------------Lining mat <br /> I e: <br /> Lq <br /> Cesspool- Distance from nearest well------ ----------Distance�r-o-m-"To-u-'n"dwation------------------- Lining-nnateria---------------------------------- <br /> Size: Diameter----:----------------------------------Depth----------------------------------------------------Liquid Capacity-----------------------------gals. <br /> Privy: Distance from nearest weIl-------------------------------------------------Distance from nearestbuilding-------------------------------------------- <br /> 0 Distance to nearest lot line----------------------------------------------------------------------------------------------------------------------------------------------- <br /> Remodelin5 andre +'ring (describe1__A <br /> ):----------- __� <br /> --- --- -----------------------------­­­­­-------------------------- ------------------- ------------------------------- <br /> -I,-- <br /> _OL---------­/4�71----- XA�._�------------I-------- --------- • ------------ <br /> --------------- <br /> —------------------------------------- -------Z7--------- <br /> -----------------------------­--------------------------------------- <br /> --------------------------- --------------------------------------------------------------- <br /> -7 -----A- <br /> I hereby certify 2f I have prepared this application and that the work will be done in accorclanc-e/ with San Joaquin County <br /> ordinances, State laws,-and rules and regulations of the,,'San Joaquin Local Health District.-`_ <br /> (Signed)- rpjARIRI� H INC --------------------(C9Wsd'1D6XGV6r Contractor) <br /> ------------------- —--- ------------------------- -------------------------------------------------------------------------------- <br /> By;__ ---- ------------------------ ------------------------------------------------------------------------(Title)------Ls-t-imat-02--------------------------------- <br /> ---------------- <br /> t <br /> (Plot plan, showing s' of I ocaiion of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> -------------- <br /> APPLICATION ACCEPTED BY--------------------------- -- ------- ----------------------------------------- DATE--------- -1-0- <br /> REVIEWED BY------------------------------------------ P <br /> V-------------------------------------------------------------------- DATE--------- -------------------------------------------- <br /> BUILDINGPERMIT ISSUED------------------------------- ----------------------------------------------------------- DATE------------------------------------------------------------ <br /> Alterations and/or recommendations------------- 'I-------- --------------- - -------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------ --- ---------- --------------------------------------------- --------------------------------------------------------------------------------------- <br /> --------------------------------------------------------------------------------------------- --------------------------------------- ------------- -------------------------------------------------------------------------- <br /> -------------------------------------------------------------- --- <br /> _4------------------------------------ ----------------------------------------------------------------------------------------------------------- <br /> ---------------------------------------------------------------- --- ------- ----------------- --- ------------------ ----- ------------------------------------------------------------------------------------ <br /> FINAL INSPECTION BY------- -------- --------------------------------------- <br /> Date----------/11------------------- -------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Sfreef <br /> Stockton, California Lodi, California Manteca, California Tracy,, California <br /> ES-9-21v! 8-SI Revised W-2100 <br />