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_ n k m"4--- APPLICATION FOR SANITATION PERMIT Permit No � lit (Complete in Duplicate)� pate Issued 5 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. i This application is made in compliance with County Ordinance No. 549. a ms ton RoaStodkton. . ------------ JOB ADDRESS AND-LOCATION------ a ___ ------.----------_""------------------------------------ -------------------- I 4-1296 C. M NIX --------------------------------------- Phone-- - --------------------- Owner's Name_-----------_----------------------- ------ - ---- "-------------_------ ------------------ 5i5' S. Sutter Stt Address------------------------•------------• -- --------------------- D. A. PARRISH & SCNS: INC. Phone_..gw9---Q7------ --- FContractor's Name--------------------------- ------------------------------------ -------------------- Installation will serve: Residence 99. Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Os� X 7 � ----------------------- -- - - Number of living units: _i-___ Number of bedrooms _Z____ Number of baths ----- : Lot ize ___'150" -- __ __"" Water Supply: Public system ❑ Community system 0 Private Depth to Water Table _4'0-- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [4 Hardpan ❑ Previous Application Made: Yes ❑ N XX New Construction: Yes No El . TYPE OF INSTALLATION AND SPECIFICATIONS: y I, (No septic tank or cesspool permit+ed if public sewer is available within 200.feet.) C C Brick ' Septic Tank: Distance from nearest well2�0`______Distant from found tion___ d -_"""-_.Ma#er�al_______________________ 8-0 ___ 6------------� No. of compartments -- ----- � e �x 6 x -,quid depth------52 Capacity �CC Cr�a.S. Disposal Field: Distance from nearest well-_$�!__ m foandatio C12"1, ------Distance to nearest l t�line_______ Q " T ' Number of lines------ '-.---- - - - L ngth of each line---------------- -----------Width of trench------------------------------------- � Type of filter material_____-- -�--�"-- - , p nce from foundation___12_t._______.Di e�to nearest I ir�_______l�t k Depth of filter material-__ _ ____________Total length______��__-_____________ ---- V + ----- Seepage Pit: Distance to nearest vel�_""_ _ --------Dista CC Hri rJl Depth -------- Number of pits----------------------Linmg material Diameter_________-- _ Cesspool: Distance from nearest well________________ Distance from foundation-------------------.Lining material------------------------------------- El ____-______-______-____________---❑ Size: Diameter--------------------------------------Depth---------------------------------- ------Liquid Capacity--------------- ------------9 --- ---------------------Distance from nearest building----------------_---------.-------- -- Privy: Distance from nearest we41_.__" _________________ ❑ Distance to nearest lot line-------------------------------- - ------- - :-=------------- - - ---------------- ------------------------ IR • Remodeling and/or repairing (describe):----------------------------------------------------- --------------""-- -------•--------------------- -------------------------------------------------------------------- -------------------•----------------------- ----------------------------------------------"_------ --------------------------------------------------------------------------•----------- r- -------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances;`S to laws, and rules-an reg a+ions of San Joaquin Local Health District. D A. P . TSH NS Ct. - ( lontractor) 5i ned Estimator --------------- ------------- B �� iT Z L'=�=='`-----------=------------ ------- Title-_----------------------------------- :. y• - (Title) (Plot plan owing size of to , ocation of sys+em in relation` o wells, buildings, etc., can be placed on reverse side}. _ F } FORD IPARTMENT USE ONLY k APPLICATION ACCEPTED BY___ DATE_ ______________________________________ REVIEWED BY DATE` - -------------------------------- ------------------------------------------- �. - DATE-------------- BUILDBUILDING ING PERMIT ISSUED------------------------------------------------------------------------------------------ Alterations ----------------------------------------------- --------------------------------------- Alterations and/or recommendations-------------------------------------------------------------------------------------------------------------------'----------------------- - --------- - ------ ---- ----------- ----- ------------- ---------------- - ---------•-------- ---- --------------- ------------------- ---------------- ----------------------- ----------------------------------- ------------------------------- / f Date----------- ----- FINAL INSPECTION BY:--------------- "-- - - ------------ --""-- SAN JOAQUIN LOCAL HEALTH DISTRICT - 130 South American Street 300 West Oak 5+roe+ 132 Sycamore Street 814 North "C" Street M Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 8-51 Revised W-2100F= '-