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Permit No. w `. APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) `$ ��, Date Issued 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. JOB ADDRESS AND LOCATION-----------------------------------------------------------S®uth Dames Street-----------Stockton ----------- ^ HO' t' IeUderdale ----------------------- Phone----Nine-------------------- Owners Name_--•-----------------•-----------------------••--------- , Same- ._ Address - --------------------------------- --------------- -------------------------- ------ D, A, PARRISH & SONS, INC . 60 Phone_9" �---------------- Contractor's Name--- -------------------------------------- - ----------- - ' Commercial ❑ Trailer Court ❑ Motel ❑ , Other ❑ Installation will serve: Residence � Apartment House ❑ Z 5�= x LUa t Number of living units:-____ Number of bedrooms __Z__ Number of baths :__---_. Lot size _________ _________________ ---- :. Water Suppiy�• Public system [� Community system ElPrivate E] Depth to Water Table _35_ ft. Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam [I Clay Loam ❑ Clay E] Adobe ] Hardpan ❑ Previous Application Made: Yes ❑ No gg New Construction:- Yes [X No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if puublic sewer is available within 200 fee- CC Brick b Dist fr oun n:�©------------.M t ial. �©---�xa-- Septic Tank: Distance from nearest well________ ___ __ g .]C �i-Liquid depth____ ? Capacity________5 ________ No. of compartments----------Z--------------size----------------- --- q 3 Y * Distance to nearest o�line________________ Disposal Field: Distance from nearest,:grell_ __------DistancE from founda �� o�I�-�_Width of trench__ 2 ------- Number of lines------------- - --- - ength-of each line---.----.i��------- Q1- - , e th-of filter mater�al__18--------------- len gth_------$__----------------- ------------ Type of filter material___ P -- Seepage Pit: Distance to nearest wel100t--_----_Distance from foundation__..10_;------.Dista0ce to nearest lot I re.5______________ (`✓ iCk -3- ----------Depth---ZZ------------------- Number of pits___-,_'____________Lining material___- -______---Size: Diameter______ Cesspool: Distance from nearest well_________________Distance from foundation___-__--_-____--__.Lining material___--_____-__--____-___.-_ _a___. Li Liquid Capacity gals• ❑ Size: Diamefier----------------- -------=-----------Depth------_--------------------------------------------- a P Y----•----------------: from nearest wel4------------------------------------------------Distance from nearest building------------------------------- Distance --,----------------,------ t � Privy: --- --•----- --------- -�- �' Distance to nearest lot line---------------------------------- ------ - - ------------------------------------- ------------------------- ti 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. • SH '& SONS INC, • * ' r Contractor)- --------------- PAP (Signed) -------•-- ---- IEstimator - - ----- --- - - -----(Title)-----------•----------------------------------- - (Plot pian, ing size of lot, location of system n relation- o wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED B _ -- ----- --- ----------------------------------------- --------------------------------------- DATE_I�----------------------------------------------------•----------------------- REVIEWEDBY--------:------------- --------------------------------------------------- QATE BUILDING PERMIT ISSUED-- ------------------------------------------------------------------------------- Alterations and/or recommendations---------------------------------------------------------------------- •----------------------- ------- --------------------------------•-- `---------------- -- -------------- --------------- JDate---------------- -------- �-- ---- FINAL INSPECTION BY:-------------------,`---- �- - __._ 1 SAN JOAQUIN LOCAL HEALTH DISTRICT f 300 West Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Street Trac California Stockton, California Lodi, California Manteca. California y' ES-9-2M 8-51 Revised W-2100