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1 - / APPLICATION FOR SANITATION PER IT et No /_-_.9-_- i , (Complete in Duplicate) S as+e Issued 2�1--7/-----Y Vwpi tion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. s application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION_________________42g___South David Street___, Stockton -- -- -- -- - -------------------------------------------------- Owner's Name-------------------------------------------------- C HA WILES 31240 Phone --•---•4 Address-----------------------;------- Sams ------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------ Contractor's Name------------------------------------------- A. PARRISH & SONS, INC. 9--9607 ----------------•--•------------------------•-•------------•--- Phone-------•---- - Installation will serve: Residence Apartment House ❑. Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -A--- Number of bedrooms _2---_ Number of baths _-_-_1 Lot size -15-"Xl2©I------------------------------ __ ___ __- _ Water Supply: Public system 9, Community system E:1Private ❑ Depth to Water Table 40-_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑- Clay ❑ Adobe4 Hardpan ❑ Previous Application Made: Yes ❑ No ] New Construction: Yes ❑ No [§upplementary 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-----__-______________________________________ EXUlting No. of compartments--------------------------Size--------------------------------Liquid. depth--------------------------Capacity----------------------- .Disposal Field: Distance from nearest- well_.----------------Distance from foundation--------------------Distance to nearest lot line_-----____-______ Exiting Number of lines-----------------------------------Length of each line------------------------------Width of tre ch----------------------------------- Type of filter material-------------------------Depth of filter material-----------------------Total length-(1---------------------------------------_- 5 ' 5 ' Seepage Pit:. Distance to nearest ryell._ --------pistanc `fros�f4 4 4 tion_-_2_.._-._-_^__,a� anee to nearest lot I#ne__•-__--______-_ I Number of pits----------------------Lining material__________--_____1-_--_- ize: Diameter.---=_____-______--____.Depth______-5________..-____. _--_ _ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------------------- ElSize: Diameter----------------------------------=---Depth--------------------- -----------------------------Liquid Capacity---------------------.------gals. A Privy: Distance from nearest well---------------------------------- -------------Distance from nearest building--------- _-__--________---___-__--__- -ice ❑ 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. ---- -- --------- C ------ - ------ -------- --- ------ C (Signed) A° P- - S ( fap Contractor] Estimator B . - ----- -- ----------- ----- -------------- {Title) (Plot pla , sho ing si of lot, location of system in relation wells, ildings, etc., can be placed on reverse side). i FOR DEPARTMENT A ONLY APPLICATION ACCEPTED BY------------------------------ -- -_-- DATE--------e1------ `-- - ----4 --------__--- REVIEWED BY DATE ------------------------------ ----- -- --------------------------------------- --------- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------- Alterations and/or recommendations------------ ------------- - -------- ---------------------------------------- ----------------------------------------------------------------------------- ------------ ------------------------- ------------------------------- -------------------------------------- ---------------------------------------------------------------------- , ----------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------ -------------------------------------------------------------------------------------------------------------- -------------------------------------------------- --------------------------------------------------------- FINAL INSPECTION BY:-----w--- ---------------------- Date'_------- --- SAN JOAQUIN LOCAL HEALTH DISTRICT It 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 5-51 Revised W-2100