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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> -------- <br /> Permit No: - ��-- <br /> (Complete in Triplicate) <br /> - ------------------------ ---------------------------- <br /> Date Issued <br /> --------------------------- ---------I---- 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 /> JOB ADDRESS/LOCATION ._r�-- -- -------/)..----- _-----------CENSUS TRACT ------=------------------ <br /> - --- ---------- - ------- ---- <br /> Owner's Name -----------Stockton_ S�'rt[t. .ria7__s __F,aerrl_ oad_ 0--------:-•-------------------Phone ---- t66 7001 -- <br /> .4. <br /> Address 133fl--North_-Broadway,__Stockton� Ca1id8; �a----------------------------- ----------- --------- <br /> Contractor's Name -------Parrish-&_Sons--hlC,---------------------------- --------License # __1_ —12- ------- Phone __.4--6-_96Q�-------.-- <br /> Installation will serve: Residence ❑ Apartment House❑ Commercial ❑Trailer Court .0 x Office Bldg. <br /> Motel ❑Other =------------------------- --------------- <br /> t Acrea e <br /> Number of living units:_.:--------- Number of bedrooms ___________Garbage Grinder•.__'------- Lot Size ________________�____,______.____.---_--. <br /> I . <br /> Private <br /> Water Supply: Public system and name ----------Ca1ifsrn�a_Trlater__3ersrice----------------------------------------------- <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan ❑ Adobe-Cr Fill Material ------------ If yes, type .--------------------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> 0 w ze - ----_5241-------- <br /> PACKAGE <br /> est_.___.__PACKAGE TREATMENT SEPTIC TANK [ Y $ <br /> Capacity 80---0-ga ---- Type PrQcM --- Material---0-oncrete_ No. Compartments ___tVo----..__._.____--- <br /> - <br /> \ <br /> II oC <br /> Distance to nearest: Well -----------None-_______________Foundation ___.--�fl-_________ Prop. Line ---1�._______._..__ <br /> i <br /> LEACHING LINE [r] f f o. of Lines -------dne---------- Length of each line.....10p 1-------------- Total Length ___19Q------------------ N <br /> 1� 19.._ _______Depth Filter Material ---_1 a-1--tn_-21---Rock-_------- \ <br /> 'D' Box �'.�'T'�s�ype Filter Material __:_____-__ _ <br /> 01 <br /> Distance to nearest: Well ___Ngne -------- - 2a'__________________ Property Line _____ -- <br /> SEEPAGE PIT C11 Depth ------25f____.__ Diameter �3."____-__ Number .__.__._( �__o e)_--- Rock Filled Yes gNo 0 <br /> .Water Table Depth ------------6Ql---------------------••-------Rock Size _1j!f-to--2'-t -dia. <br /> :If Qs------------- Prop. Line --------1-Qt-------- <br /> Distance to nearest: Well _____________None___________________Foundation -�- <br /> .il <br /> REPAIR/ADDITION(Prev. Sanitation Permit.# --------------- ----------------------------- Date __________________--------:-------) <br /> SepticTank (Specify Requirements) --- -------------- --- ---------------------------------------------------------•-----------------------------1•--------------------------- <br /> Disposal Field (Specify Requirements) ---------------------------•----- --------------------------------------------------------------------------------------------------- <br /> { 6 ---' ..�� <br /> - <br /> 'h <br /> .- I <br /> e.. {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 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 /> "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 ------------------------S�ektDn--Termir�l--&--Eastern__Railyd�ner <br /> BY Parrish__&_.Sons Inc. <br /> ------ Title ----President---- <br /> (If other than owner) <br /> II FOR DEPAitTMENT USE ONLY <br /> s <br /> APPLICATION ACCEPTED BY ------------------------ -------------------------------------------------------------- ---- 40DATE --..S ----6----k <br /> �P <br /> BUILDINGPERMIT ISSUED -------------- ---------------------------------------------------------- ----------DATE -- ---------------------------------------- <br /> ADDITIONALCOMMENTS --------------------------------------------------------------------------- ---------- --------------- --------------------------------- ----------------- <br /> -------------------------------- iI <br /> �I _ _ ---- ------------------------------------------------------------ ----- <br /> ------------ -- -------------------- --- --------------- --r3Y- <br /> Final Inspection by ----- Date _ , _?. f <br /> N JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'b8 Rev. 5M <br /> 11 <br />