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FOROFFICEUSE: <br /> APPLICATION FOR SANITATION PERMIT <br /> Permit No; ------------------ <br /> fCumplet�in Triplicate) <br /> -- ---------- <br /> ------ — - <br /> �..� Date Issued <br /> ____ _____________ -_ _- --:� <br /> _ ________-___ <br /> ' This Permit Expires 1 Year From 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 /> OB AbDRESS/LOCATION -----------------._- 3990North WiJ_son Way? Stockton _CENSUS TRACT ---------------------_- <br /> - ---------------------------------------------W <br /> #� ___ f 5 <br /> Owner's Name;-----------------•- M�.�S--A.__Paxx'�:�h-----------------------------------------------------1-------------------Phone --�56--4607---------- <br /> ' Address.-- ----------------- -------------- ]28__F�as# Mn4 '- 1Y4- -_Sc? Q �. i1itQIla1----------------- --------------------------_-------•------ <br /> Contractor's Name ------ -------------- .-_Pax'x'ash_ C__Svns,__Tnc.-------------License # ------1005U----- Phone _466_9!W----------- <br /> Installation will serve: Residence ❑ Apartment House-E] Commercial ]Trailer Court ❑ <br /> Motel ❑ Other -------------------------------------------- <br /> Number of living units------------- Number of bedrooms ------------Garbage Grinder ------------ Lot Size ----__--------_-------_--_-------_-.___-_- <br /> Water Supply: Public System and name -------------------------------------------- --------------- ------------------------------------------------Private f] <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay: ❑ Peat❑ Sandy Loam '❑ Clay Loam ❑ <br /> Hardpan ❑ Adobe-E] Fill Material -- Yes_ If yes, type ---Sandy-_C14Y'3-- " <br /> {Plot plan, showing size of lot, location of system in relation to wells, buildings, etcmust be placed on reverse side.) <br /> "y 1 <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ I SEPTIC TANK'[* Size---t_16x8------------------ ------------ Liquid Depth -------52n--.-_-_--.__ <br /> Capacity e precas�___ Material...concrete_ No. Compartments ----TWQ_:._..._.... <br /> P Y ---1-- - -2QQ---_--- Type <br /> Distance to nearest: Well --------- ©T-------------------_-Foundation -- 10,---------- Prop. Line ---P0_1 <br /> LINE [x] No. of Lines -----ane------------ Length of each line-------HiQ'--------------- Total Length -----6at----------------- <br /> 'D' Box :Pr1P99#ype Filter Material ---rVrggKDepth Filter Material --------19...... ------------------_---- <br /> Distance <br /> -_-_-_Distance to nearest: Well ----- 0t----_-_----Foundation ---20T_---_-----_- Property Line _1001.- - <br /> SEEPAGE PIT PC] Depth __251------------ Diameter 33'_'_--____-_ Number one---------------_--_- Rock Filled Yes-b No 1❑ <br /> Water Table Depth------------------------------------------------- <br /> 1 <br /> _----_60_'_ -_ -_-__-Rock Size --- ---------------------- <br /> Water <br /> -------------------------- - ------------ <br /> Distance to'nearest: Well ---- 150'-----_-----1 ___--_-_-__Foundation _8d1_---------_- Prop. Line ...75,_.__. . _. <br /> i <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------_----------------------------------- Date ----------------------------------1 <br /> SepticTank (Specify Requirements) ------------- ------------------- ------------------------------------------- ----------:-------------•-------------------------------- i <br /> DisposalField (Specify Requirements) ------------------------------------------------------ -------------------------------------------------------- <br /> -------------------------------------------------------------------------- --------------------- <br /> � w <br /> - ---------f-- -- - ------------------------------------------------------ --------------------- <br /> ------------------------------------'- -- <br /> -------- s' <br /> l t (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application and that the work will be done in,accordance with San Joaqui <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 /> "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed ---------------Milos.-A-._Parraslh.-�- - s----------- - -- <br /> n ,.• '''' <br /> - Owner <br /> - ---------. Title --- --------------------------------- ----------------------------------BY -------------- �tan <br /> ` ------ <br /> f <br /> ner) <br /> FOR DEPAitTMENT USE ONLY,d „ e r <br /> APPLICATION ACCEPTED BY .-----------'----'-------------- 5� --------------- `�--------------------- DATE _3 --------q------------------ <br /> BUILDING PERMIT ISSUED _---------------------------------------------------------------------- ----DATE ------------------------------------------- <br /> ADDITIONAL COMMENTS ------------- ----------------------------------------- - = <br /> ::/ <br /> ------------------------------------------------- <br /> ----------------- -- ------------------------------- - --------------------------------- ---- ----------------------------------------------------------------------------------- <br /> t ---- - <br /> Final Inspection b - -�~ - Date <br /> ------------- --- <br /> ------------------------------ ------- -------- --- -- - - <br /> P Y ���--- --- = <br /> SAN JOAQUIN L00�:i,`i71STRICT, <br /> E. H. 9 1-'68 Rev. 5M, <br />