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APPLICATION FOR SANITATION PERMIT <br /> (Complete in Duplicate) , <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION____------_ _-1997--_OXFORD WAY. Stockton ------------------------------------------------------- <br /> Owner's <br /> -------------------------------- <br /> 11 <br /> Owner's NameRA - -ARBQg--------------------------------------------------- - ------------------------------------ Phone---------2- 7k--------- <br /> Address------------------------------1.99-7-.--axf ord---WAY----------------------------------------- = <br /> Contractor's Name---------D--_--A}----�'ARRISH & SONS-1 rNC-• j/ Phone---- <br /> Installation will serve: Residence II Apartment House ❑ Commercial [❑ Trailer Court ❑ Motel [I Other ❑ <br /> Number of living units: Ij Number of bedrooms I]• Number of baths ❑Z Lot size------10_Q_=___.x.534!--_-_.-_------------------ <br /> Water Supply: Public system ❑ Community system ❑ Private M <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ -Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [Z Hardpan ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted .if public sewer is available within 200 feet.) <br /> Septet Tank: Distance from nearest well------3Q1--_19�stance fro{n foundation------- !_ Ivlate __ <br /> ® No. of compartments._____--_a-_3, `r00 G R <br /> t A�' ---------CapacitY----- - ------- Size-- -��---------��n--Liquid depth------------------------ <br /> Cesspool: Distance from nearest well-----------------Distance from foundation------------------- Lining material___-_--.-_-----___.-- --------_-----. <br /> :❑ Size: Diameter--------------------------------------Depth---------------------------------------------------- <br /> Privy: Distance from nearest wel{__________________ __________________________-Distance from nearest building---_-_--___----_-_-----_-__------- --- <br /> ❑ Distance to nearest lot line______________________--__-_____-______-----_-_ <br /> Seepage Pit: Distance to nearest well_--------------------Distance from foundation---------------------Distance to nearest lot line______-_--- <br /> ❑ Number of pits------:---------------Lining material-----------------------Size: Diameter-----------------------.Depth----•---------------------------- <br /> ;,.{ <br /> Disposal Field: Distance from nearest well_- a!----•pistance from foundation`--:152'---._---Distance to nearest lot line__,------------ <br /> 1K <br /> .._-_--_ <br /> ® Number of lines-._..----2-----------------------Length of each line---------5Qt--_•----------Width of trench---24"--______-•-------------- <br /> Type-of filter material--- Depth of filter material----_-_1.21 <br /> r <br /> Remodeling and/or repairing (describe):-------.I dditign.__tQ---exi-s-ting---5o9---ga1--- ata!---!P tjc-_and_______________ <br /> ----------addit-ion---to---QxisIng---Ar4x.-30-`----1oach__dra n•_and-- ro __hole---------------------------- <br /> --- ------------------- <br /> --------------------- , <br /> -------------------------------------------------------=---- <br /> ------•-------------------------------------------------------------------------------------------------------- <br /> -------------------------------------------------------------------------------------------------------------- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and' regulations of the San Joaquin Local Health District. <br /> (Signed)• D. ---------------------------------R & SQNSIINC• <br /> ---A .- - ---- ----------- ----------------- '--------------------- ' ----' [Contractor} <br /> By: <br /> ---Title Estimator I <br /> (Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be filed with this application). <br /> FOR DEPARTMENT-USE ONLY <br /> APPLICATION ACCEPTED BY.------2_-J- ---------------------------- -- ---- ------------------------------------- DATE------- <br /> REVIEWED BY----------------------------------w __ DATE-------;Z"--67-s <br /> BUILDING PERMIT ISSUED-------------------------------------------------------------- --------------------------------------- DATE <br /> Alterations and/or recommendations-------------------------------------------------------------------------------------------------------•------------------------------------- <br /> -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------• -------------- <br /> ------------------------------------------------------------­----------------------------------------------------------------------------------------------------------- -------------------------------------------- <br /> ---------------------------------------------------------- --------------------------------------------------------------------------------------------------------------- - <br /> / ---------------------- <br /> PERMIT No.__.-3 s -------- ISSUED------------- ----------(Datel FINAL INSPECTION BY:------- <br /> ---------------------- <br /> Date-------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> ES-9-2M 9-50 W4639 639 <br /> e <br />