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APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION---- 251-253___. -_ kATSAUS s Stockton _____ E " ------------------------- ------------------------------------------ Owner's Name-----_-----------2'SY'------X111_ and__Supply---pomp ------------------ ---------------------- Phone----?�-- --------- Address--------------------------------- 527 _8s• Wilson Yay� --- St4.O�C�c1ll't___... ---------------------------------- ------------------ Contractor's Name---------------�o A-'- PARRISH & SONS, INC* • '-------------- Phone--9-9607--------- Installation will serve: Residence ❑ Apartment House ❑ Commerci �prV Trailer CouFt ❑ Motel ❑ Other ❑ s g ❑ ❑ t Number of living units: Number of bedrooms Number o Lot size----lr2Q e Zl,%.r ___ __......------------- Wafer ___ ______Water Supply: Public system CC Community system ❑ Private ❑ r Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam❑ Clay ❑ Adobe [1: Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest wellX©nl_....Distance from foundation_51lvlateriai Cone-rele Cir Br Im No. of compartments______.___ __._ __Capacity____ 1®gQ___�'Size__ __�___-a7A1iquid depth--______ __ _---- Cesspool: __Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material----------------------------------- El ____________ _-___-_____ __-_____❑ Size: Diameter-------------------- -- Depth. - .------ ------------- Privy: Distance from nearest well--------------------------------------------------Distance from nearest building------------------------------------------ El _ _______________________._______--- ❑ Distance to nearest lot line------------_----------------------------------- Seepage ____________________ ________ / • n 1 Seepage Pit: Distance to nearest well _-_11Oa40__.__Distance from foundation------ ---- ance to nearest lot line 5 --------- 0Ex Number of pits--------1_----------Lining materialC10n0!!QAXize: Diame r�L _ _--------------Depth-----------------_--- Disposal --� __ $ i Dispose► Fietd: Distance from nearest Nyll___M0l'3_0__.Distance tlAouncl tiol, ___ Distance to nearest lot line_______..___ [N Number of lines____________1.. Length of each line--------- _ "- Width of trench--- --------_-__-______-__- Type of filter material__l i------4:___Depth of filter material----is Remodeling and/or repairing (describe) -------A" installations 3 store rentals♦•. No living gnartere .. -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ 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. (Signed)_.- D• At___parrish & Sons, Inc**** • • w Contractor ------------- ----------------------------------------------------------- By------------------------------------------------------------------------------------------------------------------------------------(Title)-----------Estimator (Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must'be filed with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------- �'�� ------------------------------------------------ DATE---`--�3"..112.q._/ REVIEWEDBY----- ---------------------------------------------------!------1------------ - ------------------------------------- DATE----- - ---- -----•---------- BUILDINGPERMIT ISSUED-------------------------------------------------------------------------------------- -------- DATE------- ----------_------------- --------------------- Alterations and/or recommendations----------------------------------------------- --------- --------------_---_............. --`---------------._I..------.----------- ----- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------................ -----------------------------------------------------------------------------------------.........----------------------------- -------- ------------------------------------------------......-------------- ------------------------------------------------------------------------------------------------ ---------------------------------- ------------------------------/------�---------------------------------------------------- PERMIT No�"A1_7-..... ISSUED------- 34 ------(Date) FINAL INSPECTION BY:----/` _ j` _____________________ Date ,f r ./--------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W=1639