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APPLICATION FOR-SANITATION -PERMIT1_% (Complete in Duplicate) F Application is hereby made to the San Joaquin Local Health District for a permit to corstruct and install the work herein described. This application is made in compliar`ce"with County Ordinance No. 549. JOB ADDRESS AND LOCATION-------------------2324 Country Club Blvd. Stockton, Cal« --- - --------- --------- Owner's Name------------ 'Stockton Unified ied School Distro Phone i - -- -- ------ ----------------------------------------------------------- - Address------------------------------- 2 1`1' San Joaquin Street -- - --------------------------------------------------------------------------------------------------- - D-p Parrish & Sons, Inc. ---8597 Contractors Name--------•----- '- '-' - --------------------------------------------------------------------------------------------------------------- Phone---8-8597 8 Installation will serve: Residence ] Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel E] Other E]Number of living units: Number of bedrooms Q Number of baths ULot size---290_'____x---300-------- -------------- 4r Water Supply: Public system 'Community system ❑ Private ❑ s Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑, -Sandy Loam ❑ C[ay Loam ❑y Clay E] -Adobe [N Hardpan [3. . I . IL 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-._-__-_____-------_----_-_-- I -------------------- ❑ No. of compartments--------------------------Capacity-----------------------Size--------------------------------Liquid depth-------------------------- Cesspool: Distance from nearest well----------------Distance from foundation--------------------Lining material------------__--____-----_--________- : ❑ Size: Diameter----•--------------------------'-----Depth---------------------------------------------------- 1 E .f Privy: Distance from nearest well---------------------------t---------------------Distance from nearest building---_----_----_-_------------_-_____-_____ ❑ Distance to nearest lot line____________________________'_-_----------_-_---- Seepage Pit: Distance to nearest well----------------------Distance from foundation---____----_______.Distance to nearest lot line_---_-_-__---}-_ ❑ Number of pits----------------------Lining material-----F----------------Size: Diameter-------------- __----_.Depth----------------------------#_y, Disposal Field: Distance from nearest well---110n'e__.Distance from found ti r��r_-1-4 .----- Distance to nearest lot line__1a-_Jr'-_1_ + [q Number of lines__- _ nE*-------------------Length of each iine__ U- - Width of trench-----2- ��--------------�---- Type of filter material-- -��__--ROCk Depth of filter material------------------------ Remodeling and/or repairing (describe):----------------------Additional drainage ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, .S+afe laws, and rules and regulations of the San'Joaquin Local Health District, s(SigD.A.. Parrish & Vlation ned)--------------------------------------- ----- {Owner and/or Contractor) $y. President 1----- --- --------------------(Title)---------------------------------------------------------------- (Plot plans, showing size of lot, location of system in to wells, buildings, efc., must be filed with this application). FOR DEPARTMENT USE ONLY a APPLICATION ACCEPTED BY---------- ------------------------------------------------------ DATE_....... REV]EWEb BY `-------------- "--- �----------------------- DATE_ '� ------------- BUILDING PERMIT ISSUED-------------- ------------------------ ----------------------------------------------------------- DATE - ---------------------------- Alterations and/or recommendations------------------------------------------------------------------------------------------------------------------------------------------ ------------------- i ---------------------------------------------------------------------------------------------------------------------------------------------------------------------=-------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------- PERMIT No.--k-'/-_---_--___ ISSUED__1-f--_z _` - ------------(Date) FINAL INSPECTION BY:-----W- / - - ---------------------------------- Date------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-21v1 9-50 W=1634 -- _