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Permit No. . U APPLICATION FOR SANITATION PERMIT ----••--•-•---•---••--- (Complete in Duplicate) Date Issued - Y� -�-S--- Applica{ion is hereby made to the Sanlioaquin`Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 544, 1 415 so. David AT9• Stockton t ` ------------ JOB ADDRESS AND LOCATION----- -------------------------------------- HO 3124Q---_---_-- C, H• W i les Phone-----:_---------- Owner's Name------------------ ---------•-----------------------•---•--- Ave -. . �2Q So. David Ave• Add ress - PARR ISH INC. Phone---H�---�'9 0 Contractor's Name.---------•------------------------------------------------------ ----------- ---------------- -----•------------------------------------ t Installation will server .Residences Apartment House ❑ Commercial ❑ Trailer•Court ❑ Motel ❑ Other Number of living units 1------- Number of bedrooms _2_-__ Number of baths ._ '___ Lot,size ___:5�____- - - -------------------- Wa+er Supply: Public.system 2g Community system ❑ Private ❑ Depth to Water'Table -`'�-- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay ❑ Clay C] Adobe ] HardpanE] Previous Application Made: Yes ❑ No [�C New Construction: Yes A No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank'or cesspool permitted if public sewer is available within 200 feet.) _ .r, CC Brick ...f. - None _ -- ----•'----'-'---`-- Septic Tank: Distance from nearest wall-----------------DI r w f d ion--.------- a erg ------- �� -raZ . Xjb LCL �Li Liquid d ------------fir--- -------- Capacity No. of compartments--- ---------------------5� 6311----daeej-- q ! 1Q i Disposal Field: Distance from nearest i ell.N�.ne-----Distance from found at.Qn�lg.__-__ Distance to nearest 2t ne.__ _ ___._ �VV ------------ Width of trent �y----------------------------- Number of lines__ __________ Rk Length of each rine- __ Type or filter material------------------------Depth of filter material----------------------Total length=--------------------------------------- m :-•------ t W None �� t Seepage Pit: Distance to nearest.well_____________________Distan�CfCroB�o��ueqlation____�a__.____;_ ance to nearest 12ot Number of pits.-----1- Lining material ;ze: Diameter--------•--------------Depth-------r3 = Cesspool: Distance from nearest welL_______________Distance from foundation___________________Lining material----____._____.._-__._____°__--____--. as De tl,--------------------------------=--------- ----------L:quid Capacity----------------------------g El Size: Diameter---------------------- . U , Distance from nearest building ------------------------------------------------------- Privy:: Distance from nearest well----- '---------------------------------------- ------------------=__.-------- ❑ .�. Distance to nearest lot line------------------------------------------------------------------------ ---- --------- -------- --------- --------- ------------------ --- -----•----------------------- __________________________'__F_____--____-.-_____---_____-__-_-_____________--___....___-___.__- _______ Remodeling and/or repairing (describe):-------------------------------------------------- T - -- ------ - ----- - -------- -------•-- - --------- -- ------- ----- ----------- ------ = = 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 Heal# sDistrict. 4. ' Contractor) ± PARRISH INC ` ------ ------- --- = - (Signed)-------------------------------•----- -- ' r st imator By:_-------•-------- ----------•---------•---------=------------ - --------=---(Title}------------------------------------- ------------------ (Plot pian, showing size of lot, location of system in rel tion to wells; buildings, etc., can be placed on reverse side). r FOR PARTMENT USE ONLY" ------------------ APPLICATION ACCEPTED BY-------------------------- --- ------------------- ---------- DATE------- ----------------------- -------------------------------------------------------------------- DATE REVIEWED BY------------------------------,- - :-- DATE - - BUILDING PERMIT ISSUED. ----- ---- -------- ---- -- - ------ -- .-------- Altera+ions and/or recommendations----------------_____ _ -------------------------------- ----- --------------------------------------------------- --------------------•--------- ----_-- r FINAL INSPECTION BY:----- --- ----�------------------------------= Date--- --------'-= r------------ ------- ---------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 360 West Oak Street 132 Sycamore Street 814 NorA "C" Street 130 South American Street Trac California Stockton, California Lodi, California Manteca, California Y. Fc-9-9M ; Revised W2100