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{ APPLICATION FOR SANITATION PERM Permit No. ...... —z- - (Complete in Duplicate) Date Issued Application is hereby made to t San Joaquin Local Health District for a permit to c"onstruct and install the work herein described. This application is made in compliance with County Ordinance No. 549. ------5751 Cherokee Lane JOB ADDRESS AND LOCATION-------------------------------- ---------------- ------ - --------------------------------------------------•--•-----•-------------------------------------- Owner's - - ---------------------------- Owner's Name---------- ----- -R R. -F•._Gudahl ----------------------- Phone------------------------------------ ------------------------------------- -- ---- - --- ---------------------------------------------------------------------- Address---------------------- 5751- Cherokee-- Lane------•---------------------------- D. A. PARRISH & SONS, INC . 9--9647 Contractors Name Phone ----------------- Installation will serve: Residence [M: Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __1___ Number of bedrooms _____2 Number of baths .__l__ Lot size j __'Aor'eS Water Supply: Public system El 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 ❑ No Iq 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_____________________________________________- EX.StinENo. of compartments--------------------------Size--------------------------------Liuid depth------------- ---_Ca acitY----------------- - ------ Disposal Field: Distance from nearest well_ Mistance from foundation_�0_!_____.___Distance to nearest to line...... Number of lines__________1___ _ Length of each line_____30_ Width of french______2 -------------------------- Type of filter material...1 _-_Rk__Depth of filter material__---��_ --Total length______30i______________________ ---- t Seepage Pit: Distance to nearest well'001-----------Distance from foundation--- _Distance to nearest lot line---10-____.___ Number of pits------1-------------Lining material-GG---Br*J-0 size: Diameter------- ---------Depth-------30-.------------------ Cesspool: ----------------Cesspool: Distance from nearest well_________________Distance from foundation-------------------- 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 fdescribe):-----------------------------------------------------------------------------------------------___-------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------- ---------------------------------------- -------------•---•---------------------•---------------------------------------•----------------------------------------------------------------------------------------------------------------------------------------- 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. PARRISH ;N?T.\ (Signed} - ----- ---- --- ---------------- ------- ��+�r Contractor) Estimator BY� -----= - = --------------- ---------- (Title)------------------------------------------------------------ (Plot plan, showinsize of cation of system in relatio o�wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY r APPLICATION ACCEPTED BY--------------------------------- - - --------------- --- DATE------------ - - ---------------------------- REVIEWEDBY--------------------------------------------- ----------- ------------- - ------- ------------------------- DATE-------------------- ------------------------------- BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations----------- -------- -------------- ------ ----------------------------------------------------------------------------------------------------------- - ----------------------------------- ------------------------------------ ------------------------------------- - - ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------ ---- ------- r�__ - f " FINAL INSPECTION BY- ----- ------------ -- a - .� 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