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YPermit N + ANITATION PERMIT APPLICATION FOR S - (Complete in Duplicate) Date lssued,°'I. . � 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. "r-) ' Ot-S' 14(--c & Rt 2 x 4p7A Lodi on Collier Road; 5th house on JOS ADDRESS AND LOCATION---------- ------------------- nar�-Yr---s- a---o ---tea -; -' ,C--- -gg--�S__-Why-----••----Lodi 96QQ7 WAIter---Berendt-------------------- ---------------- Phone------------------------------------ Same Address - -- D. A. PARRISH & SONS, INC. - Phone g--960 Contractor's Name----------------------------- ---------------------------------------- - ------------------------------------------ Installation will serve: Residence 4* Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ --7- ---------------------------- Number of living units: __l_ 1 Number of bedrooms2---___ Number of baths _______ Lot size ______5' -- Water Supply: Public system ❑ Community system ❑ Private4j Depth to Water Table .30_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam C1Clay E] Adobe N] Hardpan ,i S Previous Application Made: Yes ❑ No A New Construction: Yes . No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.)! Septic Tank: Distanco from nearest well_60_�_-_____Distan fro, 4ou da4ion____70_______ _.Materi#{_____CG Brick ---------------- ',� rj xb x�3 ------capacity-_800 G No. of compartm.ents------------- ---- ----Size-_ ---•------------- -------- -Liquid depth------ �r Disposal Field: Distance from, nearest well------------------Distance from foundation--------------------Distance to nearest lot line----------------- F-1 Number of lines----------------=-= ------Length of each line------------------------------Width of trench---------------------------------- Type of filter material------------0--_-------Depth of fiifer material--------- -- ---Total length------------------------------------------ See age Pit: Distance to nearest yell ____-______t_------- �lrs ;4d tion_1��__.___-_-.Dj�s ace to nearest 11. -__�'Q-_____:- Number of pits----------------------Lining material-----------------------.M : Diameter------------------------Depth------------------- -----� Cesspool: Distance from nearest well-________________Distance from foundation--------------------Lining material----------------------------------- I as Size: Diameter--------------------------------------Depth - - ----- -----Liquid Capacity---------------- ---------9 — �. = ; atance ro Barest u: a -------------------------------------- Distancen rw. .from nearest well-- J ----- ------ ---- - D f �^e b '1d'ng ❑ Distance,to nearest lot irie- --------- - -.-, .; -------------- Remodeling ----- _ -` �^ _•�,�',=�'sr,-"�,'-ewe._Remodeling and/or repairing (describe ):------- ---------------------------- ------------•---------------•----------------------------------------------•-------•-------774 --------------------------------------------------------:-----------------------------•---------------------------•--------------------------------------------------------------------------------------------------------- ---------•---------------------------- ----------------------------------------------------•---------------------------------------------------•-------------------------------------------------------------------------------------------- --------------------- I I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Count ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. Si ned D A, P ISH' S S' INC_ Estii�at� Contractor] i ( g ------- --- } Plot [a -� -- - - -----------------------------------.----------(Title)- -----------or t plan s wiliq size of [at, location of system in re tion wells, buildings, etc., can be placed on reverse side). f F6P,' EPARTMENT USE ONLY - —V l.� APPLICATIONACCEPTED BY--------- `----- ------------ ------------------------ - DATE-- -------- -------- ----------- ---------------------- ' ----- DATE - ------------- -----------�=--------------------- REVIEWEDBY--------------------------------------------------------------------------------------------------------- BUILDING PERMIT ISSUED---------------------------- - -------- DATE------------------------------------------------------- -- --------- -------------------------------------------------- - Alterations and/or recommendations--------------------------------------- --------------------I----------------------...---------:--------- ---------------------------------- ----------- --------------•------------------------------------- ---------------------_----------- -------------------------------------------------------------- FIN ------------------------------------------- '/ f • AL INSPECTION BY:_ _�:, 1 --------------- ---- 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-2300 _ Y