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ry ` APPLICATION FOR SANITATION PERMIT Q !� (Complete in Dluplicate) tion is hereb made to the San Joaquin Local Health Qistrict for a permit to construct and install the work herein described_ Applica y This application is made in compliance with County Ordinance No. 549. 11. JOB ADDRESS AND LOCATION = 'r ---$a�'keley---Ave=---Bt©GktQY1----Calif*------------------ ---------- 9 Albert P• Brasseso0 `- ------------------------- ------------------------------ Phone-----3"'5'90-------------- - ----------- i Owner's Name - - --- ---- - - - - - -------------------------- Address l!;0 - Barg ley AVei Stockton: Calf_------------------------------ ---------------------------------------------------------- Do A. PARR�SH & SWISS INC. �� * s + -`- ---_*---- ---- Phone___�9.b0_7------------- -Contractor's Name------ ------- ---------- -- ------ Installation will serve: Residence M' Apartment House;F1 Commiercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: [1 Number of bedrooms [3 Number of baths U Lot size------ -- --- -0--'----------------------- ` Water Supply: Public system EX Community system 0 Private❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ] 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 well_________________Distance from foundation ___-_______------Material_____________--_______--________---------__I No. of compartments--------------------------Capacity--[[-----------------___Size--------------------------------Liquid depth----------------------- Cesspool: Distance from nearest well_________________Distance f�om foundation__________________.Lining material-------- _-__________________.__. s ❑ Size: Diameter--------------------=-----------------Depth-------!�-----------,----------------------------- -------------Distance from nearest buiNin,Privy: Distance from nearest well------------------------------ g -Distance to nearest lot line_________________________________��_____Seepage Pit: Distankce to nearest well___041P-------Distance from foundation___)-0- ______.Dist nce to nearest lot.,line---_:�__ -_ Z . ----- Number of pits______-.___________Lining material g�'e meet Dia meter____33________ -Depth______ _ ___________".Disposal Field: Distance from nearest well__NQIIO-_-Distance from founclation20n-__-_----Distance to nearestlpt�line____�--___ ]�] Number of lines--------- -- ----- Length of each line---------- ------------Width of trench ------------------------- 12" Under Type of filter m --- .Depth of filter material__ _-_-___ • . I Sup lenient to drainage system, ,. _________________ Remodeling and/or repairing (describe):--------- p__------------ ----I----------------------------------- -------------------- --------------- ---------------------------------------------------------------------------------------------------------------------- i { I-------- ----- ----- ------ - ------- ------ - - — hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat laws, and rules and regulations of the San Joaquin Local Health District. A. P H & gON -t IhIC -' '--------------��Contractor] (Signed)------------- ' ------•--- --- By: Lt - ------ l--------- = --------------I-------------------------------- (Title)---Estimator (Piot plans, sh ing size of lot, location o system in relation to wells, buildings, etc., must be filed with this application). it FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- ----- ---- �I f --- DATE----------- --~--- "��-- J --------------- ----------------------------------------- REVIEWEDBY----------------------------------- --- f` ------------------------ --------------- ------------------ DATE------------ f U'-- ---- BUILDIN'G PERMIT ISSUED--------------------------------------------------------------- f------------ ----------------------- DATE--------------------------------------------------- ----- ----------------------------------------------------- Alterations and/or recommendations------------------ r-- " - ------------------------------------------------------------------------------ ---------------------------------------------- - --------- ----------------------------------------- --------------------------------------------ik i ----------------------------------------------------------- ----------------------------------------------- ----------------•--- - -- ----------------------- ------------------------------ ------ - i�--------------------------------------- -------------------------------------------------------------------- - - ----------------------------------------------------- ------------------------------------------- ---------- ------------------------------------------------------------------------------------------------- -------- { PERMIT No.__-_� --_ ---- ISSUED--3-----�--- --- (_/----(Date), FINAL INSPECTION BY:_--- --------- ------------- Date---------------------'� ! ----------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton!California ES-9-2M 9-50 W-1634 I� -