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.x . r APPLICATION FOR SANITATION PERMIT Permit No,z_.'a-_---_ _-- (Complete in Duplicate) ! Date Issued �/__7/`rte• Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. 1i !This application is made in compliance with County Ordinance No. 549. f _ JOB ADDRESS AND LOCATION----------1731_Palm Avenue. Stockton -- -- - -- --------------------------------------------------------------------- Owner's Name - John Cronin - 4-o657 -------•---- ----------------------------------------- -------------------------------------------- Phone---------------------------%. t ----------------------------------------------------------------------------------------------------------------------------------- Address----------------- ---- 1731 Palm Avenue' Stockton Contractor's Name-----------------------------------Do---A•---PARRTSH- &--SONS-'-- INC.------ 9!!96W------------ ---------- Phone----•--5--g6 -------_-_ Installation`will serve: ResidenceU Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑, Number of living units: __1--_ Number of bedrooms --2___ Number of baths ---2--_ Lot size -----§0 _----100___--------_---------- ----------- Water ______Water Supply: Public system [4 Community system ❑ Private ❑ Depth to Water Table -4O1ft. - \ '' Character of soil to a depth of 3 feet:' Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay p Adobe] Hardpan ❑ Previous Application Made: Yes ❑ No K New Construction: Yes ❑ No ❑ Drain supplement TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) FSeptic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material-______--_--_--_---._ -------_-_------ c'` ❑ No. of compartments--------------------------Size-------------------------------.Liquid depth--------------------------Capacity------- i Disposal Field: Distance from nearest well------- ---------.Distance from foundation--------------------Distance to nearest lot line----------------._ r Exi9ting Number of lines:----------------------------------Length of each line------------------------------Width of trench---------------------------------- Type of fitter material---------------------- -Depth of filter material-_-----_---__-____---Total length------------------------------------- � ` Seepage Pit: Distance to nearest wellNone ----------------------Distance from foundation-------?.____.---_D s ce to nearest lc� ] Number of pits--------1__--------Lining material_CC---$Y'i_C1'16,ize: Diameter-----------------------Depth-----_------------------------- Cesspool: Distance from nearest well_---------------Distance from foundation-------------------.Lining materia l-__----_---_----__-----_-----•-----g--a--l- 0 Size: Diameter--------------------------------------Depth-----------.-----------------------------------------Li uid Capacity--------- ------------ s- A rivy-: "' '_Distance from nearest well---- ---------------------------------___._____Distance 4rom nearest bui din ❑ Distance to nearest lot line------------------------------------------ .A. Remodeling and/or repairing (describe):--------------------------------------------------------------------------------------------------------------------------------------------------------- fl ---_----_---»_____________________________________________•-_--__.________.-..-_-..-------___--___----_____---.-»_-_______-._______---_-__--__--.----_-____----__--.------,-_---_-___--_-_-__---__---_----_-_____--_----___- _____________________________________________________________________________________________________..__---______-_-----____--__-------____---_-_-_-___------_-.--.-----_____.--_-__---__-_---_____-__-----____----- I hereby certify that I have prepared this application and +hat the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of +he San Joaquin Local Health District. ' (Signed)-- D €& N5 INC -------------------�1� Contractor) By:-- ------- }�- --- ----- ---------------------------------------------(Title)--------- Estimator (Plot plan, wing size of lot, location of�system in r lation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------ - -- ------------------ ---- - ------- DATE REVIEWED BY----------------------------------- ------------ DATE VVV�� - -- -- --------------- BUlLDING PERMIT ISSUED -- ---------------- % ---------- DATE------------------ --. . --------------- k Alterations and/or recommendations---------------- ----------------------=------------------------------- =----------- ------------------------------------:------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- r -----------------------------------•------------------•-•--------------- ---------------------------------------------------------- ------------------------------------------------------------------------ ---------- -- – -----------•------------------------------------------------ --------------------------------------------- -------------------------------------------------- --------------------- --------------------•--------- ---- .. t 'k --------•--------------------------------------- ----------------------------------------------------------- -------------- FINAL INSPECTION BY:. ------------------- Qate ~L - �'"' -- - i SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American-Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, Californi a Lodi, California Manteca, California Tracy, California rk ES-9-2M.8-51 Revised W-2100.