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, �ps�" 1 Permit No. __.. ---7_.•---- ---- pLI.CATION FOR SANITATION PERMIT ��„� �(Camplete in Duplicate) Date Issued .___ _.� + t the San Joaquin Local Health,District for a permit to construct and install the work herein scribed. 1Appleca ion�is hereby made o q This application-isinade an compliance with County Ordinance No. S49. 3130 No. "Fs" Street„ Stockton JOBADDRESS AND LOCATION------------ -- ---------------------------------•------------------------------------------------ ---- ••-- ------ P.T R, Glenn Jones Phone__ 3 22----------------- Owner's Name --•-----•-----------•------ ------------ , 8160 Encino . ----------------- ------ ----------•-------------------------------------------------� ---------------- Address --------- Address------- - •-- - -- --- PARRISH INC . -e o 0 -------•------------------------- Contractor's Name-----=-----------------•--------------•-------•------•---•------ •-------- ------------------------------------------ i - Installation will serve: Residence ❑ Apartment House &X Commercial ❑ Trailer Court ❑ Motel ❑ Other F loo T a 1601 ----- -------------------------------- Number of living units: �`0__ Number of bedrooms'-_d-,. Number of baths__'_ Lot size ____________ _____ ___ Water Supply: Public system� -Community system ❑ Private ❑ Depth to Water Table 40___ ft. Character of soil+o a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay El AdobM Hardpan ❑ ' t Previous Application Made: Yes ❑ No.[X New Construction: Yes& No ❑ s [ TYPE OF INSTALLATION AND SPECIFICATIONS: r (No septic tank or cesspool permitted if ublic sewer is available within 200 201 CC `Brick � ane Septic Tank: s Distance from nearest w II-----------------Distan Uo u anon--.--------_--:----M&iiia----- -----` OO Cs&� l f _ 4 6 d X Li id de th--------------------------Capacity.3---•--------- No. of compartments _----------------Size_..__ a-••$e P 1 None Disposal Field: Distance from nearest well______ __________Distance from fou ao�C �- -- Distance to nearest ly�tOle--- _.-------- ------- . ---- 3 Number of lines------ __-1 _ R -Length of each line----------IF Width of trend 60—_________________.-_ ------ ------- Type of filter material_-- _-____..- Depth of filter material____--______�-.__-.__Total length------------ __----------------------- Type _________________ FNone .-_ _'_-_Distance fp�n fouppd�ation_-la-___.-.._ �i�tancb to nearest-lot�i3et__s -- Seepage Pit: Distance to nea4st.� C�ririC!{ r Number of pits----------------------Lining material---- Size: Diameter-:-----•---------------Depth----- l Cesspool: Distance from nearest well_________________Distance from foundation.-- .___.Lining,material gals- El .._Liquid Capacity--------------- ------------g { ❑ Size: Diameter------------------------------•---- I Privy: Distancefrom nearest well------------------------- .-Distance from nearest building--:--------------------------------------- ------------ ❑ Distance to nearest 4ot line-------------- -----•-------------------------------------'- -= Layout subject to slight change if underground ------------ -Remodeling and/or repairing (describe)---------------------- -------------- - -•--------------- obstacles are encountered: -------------------------------------------------I---------------------------------------- ---- ------------------------------------------------------------------------------------------------------------------------- ----•------------------------------------- --------- - - -------------------------------------•------------------------------•------------------------------- ---- 1 hereby certify that I have prepared this application and that the work will'be done in accordance with San Joaquin County Y ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. PISRINC. e • • - • ♦ • • • ♦ e • • • e Contractor) (Signed].____ - Estimator ---------------(Title) --------------•--------------------------- ...... By: = - - (Plot plan, showing size of lot, locatio system in relation to el , buildings, etc.,.can be placed on reverse side). l i FOR DEPARTMENT-USE ONLY - DATE------ ----------�.--- APPLICATION ACCEPTED BY---- ---------------------- -----------`-- ------_-- -5 ---------------r ---- -- IJ --------- - DATE-----------------------•- ---------- REVIEWEDBY-------------------------------- --------- -- ------------- -;-- --------- - - ----------- BUILDING PERMIT ISSUED--------------••------------------------------------ ----------------------------- ----------- ------ DATE-------------------------------------------------------------- Alterations -------------------------------------------- Alterations and/or recommendations--------------------------- ------------- ----•------------------------------ ! `------------:�------ ---- •--_._ -----•• - ... ------------------ =-------- f,� ia�---- vim:--��rj ti a _ '% ---------------------------------------------- ----------- ----------------- �. ----------------- ------ --------------------------------------------------------------- / " a L�----------_-------------•---- FINAL INSPECTION BY:.__-_-.._--._._:__. - r� ------------ --------- Date ----- ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street 130-Scufh American Street Tracy, California Stockton, California Lodi, California Manteca, California FS 9-2M : Revised W-2100