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np y�3 APPLICATION FOR SANITATION PERMIT Permit No. �.o-.°�-_I--- [Complete in Duplicate) /V Date Issued / k. Application is hereby made to the San Joaquin Local Health District for a permit fio construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. 1670 Berkeley Ave, Stockton JOBADDRESS AND LOCATION------------------ - - - — ---------------------------------------------------------------------------------------- --------------------------------- Owner's ----------------------------- -- Owner's Name------------ ---- ..-i.- Ray Wolfe -----------------= ------------------ Phone. Mc�$$ '---------- Address-----------------------_--• - 1b70 Berkeley--------------Ave, Stockton-----------------------------....--------------------••---------- Parrish Inco - Contractor's Name------------------------•----•----------------• ---------------------------------------- ----------------- --- ----- ---------------- Phone----9--------07-----•------ Installation will serve: Residence 41 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ t Number of living units: _.1-- Number of bedrooms 2...... Number of baths 1---.- Lot size 5.0....-X..-120-------------------_-..._.-....- Water Supply: Public system [4 Community system ❑ Private ❑ Depth to Water Table . . ft. Character of soil to a depth of 3 feel: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe it Hardpan ❑ Previous Application Made: Yes ❑ No IN New Construction: Yes ❑ No ❑ Supplementary Drainage 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--------:----------------------___-.-_-...... EXUting No. of compartments--------------------------Size.-----•------------------------Liquid depth--------- -- --- -------1-Capacity----------------------- Dispoosal Field: Distance from nearest well----- -Distance from foundation--------------------Distance to nearest lot line----------------- EXtirig Number of lines----------------------------------Length of each line------------••--------------- Width of trench-----------------------------------il (� ' Type of filter material--_------.-_-----------_Depth of filter material------ .Total length-:---------------------------------------- . ne a r._.. 1 Seepage Pit: Distance to nearest well-.-140------------- from 8' 51 to nearest to lue---fir-- Number of pits-------- 1----------Lining material..-C.'.C'.-C --Size* Diameter----33--------- --.Depth.. 30 i Cesspool: Distance from nearest well:................Distance from foundation;.._--- -------.Lining material.-.------------_.-_-----------__--- ❑ Size: Diameter -- --------------------Depth------------------------------ - i a -. r--------- Privy: P - Liquid Capacity---.,_--- gals Privy: Distance from nearest well---._-------------------------------------------Distance from nearest building__ ----------_----------------------_ ❑ Distance to nearest lot line---------------------- .. d Remodelingand/or repairing (describe):------------------I----------------------------------------------------------- - - ---... ------ -•---•---------------....------•-----------------------• -----------••-•------------------------•------------------- ------------------------------------------------------------------------------------------------- -------- ----------------------- ----------------------------- t ----------------------- - ---------------------------------------------------------------------------•--•---------------------- ------------------------------------ ---------------------------- ----------••---------------------------- -------------••---------------------------•------------------------------------------------------ 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 a re lations of the San Joa in Local Health District. Parrish Inc, ISi ned -------------------------- ------- ------ ------------ ----------- - ---------------------- ------[ Xr Contractor) Estimator By:------------------------------------•----------------- -- ---------- ---- ------ ------ - ----------------------(Title} - - - --------------------------------- --------- (Plot plan, showing size of of, location of stem in relation to wells, uildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------------------- DATE- r�- ------------ REVIEWEDBY------------------------------------------------- --------- ----------------------------------------------------------------- DATE.---------•- ------------ ------------- BUILDINGPERMIT ISSUED----- ------------------------------------------------------- ---------------------------------------- DATE-------------------------- ---------------------------------- Alterationsand/or recommendations:------- -- ---------------------------------- ---------------=---------------------------------------------------•--------------------------------- ------- ---------••----------------------------------•-------------•-•-•------------------------------------------------------------------------------------------------------------------- --------------------------------- -----•------------------------------•-------------------------------------------•------------------------•---------------------------------------------•------------------------------------------•------------------------- ---- ---- ------ ------------------------ ---------------------- ----------------------------- -- ---------- --------------------------------- - FINAL INSPECTION BY---------------- --- ----- - ---- - --------------- Date . SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North •'C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M ;0-52 Revised W-2100