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P . . �� -� A�PPf.ICATION FOR SANfTATiON PERMIT Permit No.�"-" � . � ,., r� ��p� " (Complete in Duplicate) .5 . t. pate issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. - JOB ADDRESS AND LOCATION--- 959 So. Broadvilwy St, Stookton _"-_"""" ---- - - -- - ------ •----------------------------------- -----------------•----------------------------- Owner's-Name----------- Samuel N, Thomson 2-2279 -------------------------------- - Phone-------------------------- Address---------------------------------------------------------Same Contractor's Name-----------------------------------D,- A. PARRISH & SONS INC s , 9Mgba7 ------------------------------------------- --------- ------------------------------------ Phone---- ----------------------------- Installation will serve: Residence 99_ A aarrtment House ❑ Commercial E] Trailer Court ❑ Motel El Other E]Number of living units: Number ot bedrooms 2--__- Number of baths 1Lot size ___-591:4:0-1 ----------------------------- Wafer Supply: Public system X Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Q Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No.)P ,New Construction: Yes ❑ No ❑ Supplementary drainage TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic fank`or cesspool permitted-if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation--__--_--------_-_.MaterialE sti� No. of compartments-------------= - --------Size--------------------------------Liquid depth--- ------------"- -_-"--"Capacity aacit -------------- -- Disposal Field: Distance from nearest well_"!1-4_ G-_.Distance from foundat 10 R Distance to nearest J,� line____5------ t�Sf ~ti * Number of lines__-- "_"____i -- "Rk""-.Length of each line------ - -- -------- ---Width of trench---#_"_---"-- ------------- ------ Type of filter material___- ---__.___--Depth of filter material- ---------------------- O -----Total leng#h---�--- --------------------------- Seepage Pit: Distance to nearest well---------------------- from foundation--------------------Distance to nearest loft line--------------- E2Mstlng Number of pits----------------------Lining material-----------------------Size. Diameter-------------- ------.Depth----------------------- Cesspool• Distance from nearest well_-"-------------Distance from foundation---_-___Y-.____--..Lining material---------------------_---_. ;❑ Size: Diameter------- ------------------------------Depth----------------------------------------------- ----Liquid Capacity------------------------ gal Privy: Distance from nearest well------------------------------------------------- ` 4 -__"--__-"""Distance from nea` rest buildingEl _"_"---__"""____."""_ Distance to nearest lot line -•------------------- Remodeling and/or repairing (describe): Ditchhas been hand- dug For several months and i----------•------------------------------------ ------------ ar > h__&_Soni__are_""merely eompletri _-thy fob _am-_-� This__is a sup--lenient drain"".s"... -- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------•------------------------------------------ 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 A, P H & S S 9 INC+ 0 « -------- CiW C By%. - ._"! -•--- •... .. - [Title Estimator Contractor �-------- - (Plot plan, s ing size of lot, location of sysfem i rel ion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY f APPLICATION ACCEPTED BY-- ------------------------------------------------------------ - _ DATES _-- REVIEWED BY--------------- ---------------------------------------=------------------------------ DATE_---- BUILDING PERMIT ISSUED--------- DATE__;-_ �� * BATE -------- Alterations and/or recommenda-4ons�� -. _ r _ ------ ---- - ------------- ----------- ------------------- "f _ � -.- -_- ---- '`' -- --------------------------------- ------ - -------------------------------------- n--- -- --�------ - -- --------------------------------------------------------------- FINAL INSPECTION BY:. ------------------ `' = Date---------- r,� _ ----------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street -300 West Oak Street 132 Sycamore Street 814 Nor+h "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 8-51 Revised W-2100 7