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-�A APPLICATION FOR SANITATION PERMIT Permit Noc�_.5.�-___ (Complete in Duplicate) +� -�. Date Issued -a_-_7/-S-�3 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. 59.9. JOB ADDRESS AND LOCATION-------2136 Orwoods Stockton - - - - - • -------------------------------------------------- -•-- ----------------------------------- Owner's Name------------------------ :A, W, Perry - •--a ------------- --------------------------------- -------... Phone------------------------.------ me Address--------------------•---------------- ----•-------=•: ------------ Contractor's Name----"--.•---------►---___-- PARRISH IN C e gwg6o _ --------- ------------•---------------_•-•--- __ one----• Installation will serve: Residence.] Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:1._-_- Number of bedrooms 2------ Number of baths _-_1. Lot size __-�O_=__x__100$ Vr -------------------------------- Water Supply: Public system„12; Community system ❑ Private ❑ Depth to Water Table�5_-_ ft. Plus Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [] Clay ❑ Adobe Qg Hardpan ❑ Previous Application Made: Yes ❑ No)C1 Neuf 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 nearesi well--------------_.Distance from foundation--------------------Material__-----_. _-.--.--._-__-. E%�ptirng No. of compartments---------- -- ----------Size----•---------------- -----.-Liquid-depih__.------------- ---------Capacity Disposal Field: Distance from nearest well-----------------.Distance from foundation--------------------Distance to nearest lot line-_------ --_--- Exn3ting Number of lines------------- ---------------------Lerrgth of each line------------------------------Wid#h of trench-------------------------------- W Type of filter material--------------- ------Depth of filter material-----------------------Total length--------------------------------•--------- Seepage Pit: Distance to nearest well_None---------Distance Cf�orQ, o n�c`{ation__1�_---_..---. i tince to nearest,( �ine______-l0_t_ $,K Number of pits---- --------- Lining material.- ze: Diameter---------------- '-----Depth------------- ------------------- Cesspool: Distance from nearest well-----------------Distance from foundation---- Lining material------------------------------ ------ ❑ Size: Diameter - ------------------=---------Depth--------------------•-------------------------------Liquid Capacity-----------------------------gals. Privy: Distance from nearest well------- ------_---_----------------'__"-Distance from nearest building ❑ Distance to nearest lot line------- -------------------------------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):-------------------------------------------------------- ----------------- ..._..-_.-_.--------------------------------------------------- ----------- -------------------------------------- ------ ---------------------------------------------------------------------------------------------.__-----__--_.----__--------------___--.----_--------._.-_-...- I hereby certify that I hove 2preared this application and that the work will be done in accordance with San Joaquin County ordinances, State lawsand rulelations of the San Joaquin Local Health District. PARRISHI x�(Signed)----------------•------------•• • = --- -- --------='---------------------------------------------------------- {6WContractor) BY: -------------------------------- Estimator-----------------------------------------{Title) ---------------- ---r----- - -,_ - - - - - ---------------------- (Plot plan, showing size of lot, lovystem in relatio o we ls, buildings, etc., can be placed on reverse side). ( FOR D ARTMENT USE ONLY APPLICATION ACCEPTED BY--------------- ---- ---0,0 --- -------------------------------•---------- ------ DATE---------Y- -7-- ------------ REVIEWED BY ------------------------------------------------------ DATE--- ----------------------------- UILDING PERMIT ISSUED:--------•--------------•------------------------------------------------------------------------- -- DATE.---- Alterations and/or recommendations:----- ----------------------- - ---------- ---------------------------------------•---------- --------------------------------------.-------------------------------------------- ------------------------------------------------- -- •--•- ---•----------------- -- - ------------- FINAL INSPECTION BY:.-_' y Date- �� a. . ---------- --------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C” Street Stockton, Cal;Fornia Lodi, California Manteca, California Tracy; California ` ;.. ES---9-2M 10-52 Revised Vti/-2100 as_c.