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SANITATION PERMIT Pe/mit AAPPLICATION FOR S , [Complete in Duplicate] �_ S Av) Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549, JOB ADDRESS AND LOCATION_____11, Cardinal Avenue- = Stockton ---------------------------Ch-.ries Scott Owner's Name------.---- ----------=-a Phone Address________________________________________ -114 Cardinal. Avenue 1 r -----a D44, PARRISH & SONS '- INC. Phone__9"9607 Contractor's Name------------------------------- ------- ---------------------------- - ---------------------------- Installation will serve: Residence Pq Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _'_2____ Number of bedrooms 3---- Number of baths ____ - Lot size 100 X 1007 -------------------------- Water Supply: Public system #] Community system ❑ Private ❑ Depth to Water Table 40.__ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ - NoZ] New Construction: Yes ❑ No ❑ Supplementary Drainage TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well---.-------------Distance from foundation--------------------Material---__--_-----__-_-___--_----___---___--_-----_-_. E2)sting No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity----------------------- k Disposal Field: Distance from nearest ell___ 1 ------1#tance from foundatio __�; '�' Distance to nearest I t line__ __________ p Number of lines___-_____-_ - Length of each line_______ �_� Width of trench____��_____________________ F Type of filter material____ 2��ftk_____Depth of filter material___gn_______-,___Total length______�4 fi__________________________ Seepa „Pit: Distance to nearest well---------------------- from foundation----...------------Distance to nearest lot line_______________- Number of pits----------------------Lining material-----------------------Size: Diameter------------------------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation---------------------Lining material--------------------------____--._--. ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------Liquid Capacity---------------------------gals. Privy: Distance from nearest well------.------------------------------------------Distance from nearest building---------________________________________- ❑ Distance to nearest lot line--------------------------------------------------------------------------------------------=-------------------------------------------------- Remodeling and/or repairing (describeJ:__._ __Well not In use will be frilled in by owner T— -----------------------e----------- --- -- - City--mer service the prem ses. --------------------------------------------------•------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances laws, and rules and regulations of the San Joaquin Local Health District. D. 16 PAR.RIS & S) I (Signed) ------------ ---------------- --- ------- - ------------ -- ----------- -------'------------------=------------------------ -- ---- ----{Owner and/or Contractor) Tale Estimator ----------------------------------- ---- (PI plan, sh ing ize of lot, location of system in relation o wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BYL-!�------------------- -------------------------------- DAT -------------------------------------------------- REVIEWED BY------------------------------- --------------------------- ----- ------------------------------------ DATE-- BUILD€NG PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE----------- Z ------------------------------------------ Alterationsand/or recommendatisons----------- --------------- -------------- ------------------------------------ ------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------- ------------------------------------------------------------- ------------------------------------------------------------------ 4FINAL INSPECTION BY--------------- /-f/--- -------- --------- Date---- ------------------------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 8-51 Revised W-2100