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1 s Permit No, APPLICATION FOR SANITATION PERMIT Complete in Duplicate) — (� Date Issued plication 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. S49. JOB ADDRESS AND LOCATION_�_''___5314 E. Dana Street, Stockton ------ - ----------------------------------------------------------•------------------------- Owner's Name----------------------------- ---Daniel Sullivan ------•------------- --- --------------------------------------------- ------------------------------------... Phone--- -------------------•------------ Employee's Dormitory San Joaquin General Hospital Address-------------------------------------------------------------------------------...-.---•------------------------------------------------------------------------------ Contractor's Name PAhRISH INC. Phone-----g,Q6o7------------- ------------------ •-------------------•---------------------------- Installation will serve: Residence a Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of livirig units: _.1-- Number of bedrooms -_2___ Number of baths ---k-. Lot size __AC! -x_ 12-0--1--- _ _Water Supply: Public system ❑ Community system ❑ Private ] Depth to Water Table ____oFt. Character of soil to a'depth of 3 feet:: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No 'P9C 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.) t Septic Tank: Distance from nearest well-----------------Distance from foundation..-.----------------Material-------- ___________.___________________-.-__._. Eting No. of compartments-----------------------_--Size--------------------------------`Liquid depth------_ ------Capacity---------_------------- Disposal Field: Distance from nearest we€i____f_______._._.Distance from foundation--------------------Distance to nearest lot line----------------- ::.sting Number of lines---------------`------------ ----Length of each line------------------------------Width of trench-----------------------------_ Type of filter material--------------_:_________Depth of filter material-------------.---------Total length______________________________________._ Seepage Pit: Distance to.nearest l ell___l0d___.______Distanc f�orp oun tion-__. ---�____._.Distance to nearest lot linet..-20_--__.._ � Number of pits_________-------------Lining material-------:----__.____..__. ize: Dia'meter__33______..__..____Dept h_._._..25_______--____.._ Cesspool: Distance from-nearest welt-----------------Distance-from foundation--------------------Lining material__.____.__.__.___._____.______-_. Size: Diameter--- Privy., iameter-- --=-----___-.- .-_-- be th__=___:_:___r_.-_-- _-- ' --`- --Li Liquid Capacity_: ❑ -.. p q _ gals: Privy: Distance from nearest well------------------w-------------------------------Distance from nearest building__.______.____________________.__..__._._. ❑ Distance to nearest lot line----------------------------------------------------------------------- ---------------------------------------- - ----------------------------- Remodeling and/or repairing (describe) ---------------------------------------------------------------------------------------------------------------------------------------------------- -------•----------------•--------•-•----------------------------------•---------------------------•---------------------------------------------------------------------------------------------------------- ----------------•-------------------- -------•---•------------=------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------- 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. P.ARRISH+, IN C s w.# nr (Signed)--------------------------------------------------------- KY ux Q4YXXContractor) " Estimator BY:--------------------�--------------------------------- --- ------ ---- ---- ----- ---------------(Title)---------------------------------------------------------------- (Plot plan, showing size of lot, location of tem in relation tow s, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------------------------- .--------=----------=--------------------------- DATE------ REVIEWED ----REVIEWED BY------------------------------------------------------------------------------------ ----- -----•---•-------------------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------- DATE-------------•------------------ ---------------------------- i Alterations and/or recommendations:---'-----------------------------------------=-------------------------------------------------------------------------------------------- --------------------------------------------------------------•---------------------------------------------------------------------------------------------------------------------------------------------------------- ----------- ----------------------•----------------------------•-------•---------------------------------------------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY:. -� Date---- l�.d/----�-------------------------------------- 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 io_s2 Revised W-2100 E