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i II �j APPLICATION FOR SANITATION PERMIT Permit No. ` (Complete in Duplicate) !o 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____________________5653 Cherokee Lane --------------------------------------------- ----------------------------------------------------------------------------------- Owner's Name----------------------- 'TOhn_ MU37_p)�y--------------------------------- ----------- Phone------------------------------------ ------------------------------------------------- Address........_-.-------------------------1.7.62 tuxedo Stockton'California ----------------------------------- - --- ----------------- D A Parrish & Sons Inc HO b-9b07 Contractor's Name ------------• '=------------------------------------------------------------------------------------------------------- Phone Installation will serve: Residence ® Apartment House ❑ Commercial [] Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .-_2Number of bedrooms _-_�_ Number of baths _2___ _ Lot size ------2___`creme-----------------------------_-_ Water Supply: Public system El Community system E] Private ® Depth.to Water Table __45 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay E❑ Adobe [3 , Hardpan ❑ Previous Application Made: Yes ❑ No$] New Construction: Yes ❑ No ® PHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest welt________________Distance from foundation------------------..Material-___-___--_-__---------______________-____--_ Exi©Iring No. of compartments--------------------- Size----•-------------------------._Liquid depth--------------------------Capacity------ ---------------- Disposal Field: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line----------------- Number of lines----------------------------------- ------------------------------ of trench----------------------------_- �',Xi 9t,ng Length of each lineWidth- ----- Type of filter material-------------------------Depth of filter material-----------------------Total length------------------------------------------ Seepage Pit: Distance to nearest well -----------------from foundation---?:t'fl_t________.pis3t r�4e to nearest l0 7 _____5_'___--_ N" Seepage ® Number of pits........ _____--_-__Lining material___rOCk Size: Diameter--------___- ---------De th______ Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material------------------------------------- El =_-.___-__--_._.__._------_______❑ Size: Diameter--------------------------------------Dept h-------------- -------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building--___._.___-______--------___-____-.____. ❑ Distance to nearest lot line-- - 1 ---- ' Remodeling and/or repairing (describe]-------- ----- --`--------------=-----------•------------- --------------------------------------- ------------------•------- ----------- :Adi o existiris--syst-eii----------------------t-------------------- } ------------•--------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------I---------------------------------------------------------------------------- ----------------------------- --------------------------=--------------- ---------------------------------------------------------------------------------------------------------------------------------------=------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)--------Pa.rr_i_sh__&__S ons----Inc--- --------------------------------- ----- --------------------------------------------- - - (Owner and/or Contractor) u Br--------------------- Bill Wright------- � Est {Title)------------------------------------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY _ a APPLICATION ACCEPTED BY--------------------- DATE----------� A------------------------------- ---------- ' . - ----------------------- REVIEWED BY------------------------------------ -DATE I ------- BUILDINGPERMIT ISSUED-... 4--------------------------•------------------------------ -- DATE----=--------•--------------------------------------------- Alterations and/or recommendations---------=--------------------------- ------------------------------------------------------------------------------------------- -------------------- -----------------------------------•----------•---- ------ ---- ---------- -- ------- - -----------------------•------------------••--------------------------------------- ---------- --------------------- --- ----- ---- ---- -------•------- -- ------- --- -------- ---------------------------•----- •-------------------------------------------------------------------- fi FINAL INSPECTION BY:.. ---- -------- -- ------ Date--- --- - " SAN JOAQUIN LOCAL HEALTH DISTRICT .7 130 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 . Ravisoa 1.57 F.P.CO.