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9 J APPLICATION FOR SANITATION PERMIT �� .rr tO_ I � f (Complete in Duplicate) 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----- 1755--0o•------Olive---- treet -_-_------ - Owner's Name--------------- Fred A. ha Goss 4-7215 - - ---- - --- - - - ------------------- -------------------------------------------- Phone------------------------------------ ` Address1755 So. Olive Street-------------------------------------------------------------------------------------------------------------- ----- D A Parrish & Sons Inc. � Contractor's Name ------------------------------ -=------— ---------- ------------------------------------------------------- Phone---9 6x7-------------- Installation will serve: ResidenceXX Apartment House [] Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of livingunits: �.N 142 acre ��. umber of bedrooms [� Number of baths] Lot size________ ____ _ _ __ Water Supply: Public system ❑ Community system ❑ Private [N Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [X 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----4Q1-------Distance from foundation0' Me _IBrick 611 ----------------------- No. of compartments----2------------ -----CapacityaoQ__G--------Sizz ___�3__ = 63 _Liquid depth-�2------------------- r I. Codd g COCJOBma Cess ool: Distance from nearest well___�Od -_Distance from foundatio _______________.Linin ma+erial_________________________________-_. �" . Size: Diameter_:_508--------------------------Depth--------Q201--------------------------------- Privy: ----------- - -- ---------- Privy: Distance from nearest well-------------------------------------------------Distance from nearest building___.___-- _____________-____________- ❑ Distance to nearest lot line------------------------------------------------ Seepage _____________________________________________See a e Pit: Distance to nearest well_____- il____Distance from foundation_-9C_f _ ___-Distance to nearest lot line f Ex p '1 C C Br 33u 20 Z----------- . Number of its______________________Linin material_____________________��Z�: Diameter___ - ---------------Depth --------------------------- ,.Disposal Field: Distance from nearest well------------------Distance from foundation--------------------Distance to nearest lot line_____.______.. ❑ Number of lines-----------------------------------Length of each line------------------------------Width of french------------------------------- Type of filter material-________________________Depth of filter material___________--__-______ Remodeling and/or repairing (describle):-------- -e'Ali---installat-i-oTl---0--0-------------------------------------------------------------------- ---------------------- 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 and regulati ns of the San Joaquin Local Health District. [Signed) = x rofs INCA---------------- -------------------------------------------------------- -------[� Contractor) By: -�----- ----------------------------------------------------------------------(Title)Estimator------------------ (Plot p s, of lot, locatin relation to wells, buildings, etc., must be filed with this application). s i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--(:—?:------ ----------------------------------------------------------------------- DATE----cam --- -- ------------------------------------------- -------- - --- - REVIEWED BY------ - -- ------------------------- -------- DATE----- 4� BUILDING PERMIT ISSUED--------------------------------------------------------------------------------=--------------------- DATE Alterations and/or recommendat ions:--------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------ --------------------------------------- ------------------------------------------- ----------------------------------------- --------------- -----------------------•----------.._..--------•-------------.-----------------.---------------------------------.------------------------------------.----------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------=--------------------------------------------------------=----------------------------------------------------------- -----------------------------------------------------------------------------------------------•=-----------------------------------•--------- ----------------------- p- // (Date) FINAL INSPECTION BY:________ PERMIT No.-__5 aA_-------- ISSUED---- /__J-- -L------------- I W- 5------------e------------------------------ Date------------------------------- l + SAN JOAQUIN LOCAL HEALTH DISTRICT + 130 South American Street Stockton, California ES-9-2M 9-50 W4639 x