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! APPLICATION FOR SANITATION PERMIT Permit No. ____' __¢f_'_._�r (Complete in Duplicate) .� Date Issued ._-• ---_ ---- --- Applica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work here n de cribed. This application is made in compliance with County Ordinance No. 549, JOB ADDRESS AND LOCATIONI.-___4'�1 Palmer Avenues 5tocktorX (Cherryland & Pape y Owner's Name---------------------------------'-- _ Sde La Gi©rdano �+» 901 ---------------- -------------•------------------------------- -- ------------------------------------ Phone---------..... --------------------- Address------------ -_ { Same -- PARRISH INC. -- Phone----9".9607------------- Contractor's Name--------•--------------•- ----..._.-..----------------------------------------- •------------------------•-•----------------- - • Installation will serve: Residence] Apartment House ❑ Commercial ❑ Trailer Court ❑ ',Motel ❑ Other ❑ rt 1 Number of living units: __1_._ Number of bedrooms ._' -__ Number of baths --- . Lot.size _____7d__.__X 1 0 Water Supply: Public system ❑ 'Community system ❑ Private Depth to Water Table -------- ft. - Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy loam ❑ Clay Loam ❑ Clay ❑ Adobe 9 Hardpan ❑ Previous Application Made: Yes [] No PC New Construction: Yes ❑ No ❑ Supplementary. Drainage 1 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) + lw - X� Septic Tank: Distance fromInearesf wek_��_..�.___Distance from foundation-----------------___Material--------°____________x_____-_.____.______ ___. Fjisting 'No. of compartments------------ ------------Size-----------------------•-------Liquid depth-------------------------Capacity----------------------- Disposal Field: Distance from nearest well_�0.1___.._Distance from founds -on l _________.Distance to nearest loLf line__,r__t_________ 0 EjUstIng, Number of lines___1________ _ Length of each line___��_-.__ Width of trench_ 2-4-_______________________ and add a Type or filter material_________________________Depth of filter material----------------------- length--------- ---______.--------------.------ Seepage Pit: Distance to nearest well-_--------_-----------Distance from foundation--------------------Distance to nearest lot line------------------ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from Inearest well--------_--------Distance from foundation--------------------Lining material---------------------__.____-__-_____. ❑ Size: Diameter-------•-----------------------------Depth---------------- ------------ ------------------...Liquid Capacity------------------------------gals. Privy: Distance frorri;nearest well----------____________'-------:------------------Distance from nearest building—,________________-____-____________- ❑ - Distance to nearest lot line_______________________ - --------------------------------------_-------------------------------------------------------------------------------- Remodelingand/or repairing (describe):----------------------------------------------------------------------------- ---------------•--- •-.......................------------------------------- r ----------------------•--- - � r ------------------------------------------------------- _..------- ------ --•------- ----------------------•-----------------------•-•----------------------- Thereby 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. PARRISH .INC , . (Signed) ---- ------------ ------------ - ------------------------------------ ------------------------0)UXAr Contractor BY-------------------------------------------•.-.- ---- --------- {Title Estimator (Plot plan, showing size of lot, location of sy a in relation to wells, ildings, etc., can be placed on reverse side). r ' FOR DEPARTMENT USE ONLY i APPLICATION ACCEPTED BY----- -------- _- - ---------------------------------- -----••---------------- DATE �-- --------------- REVIEWED BY------ ----------------------=-' DATE BUILDINGPERMIT ISSUED----------- ----- -------- ---------------------------------------------------------- DATE------ ------------------------------------------------------ Alterations and/or recommendations:--------------------------- --------------------- --------------------------------------------------- ---------.. ----•----•.-------------------•--=---------- b T __________5_.---------------------------------------------------------------------_----------------------------------------------------------------.---------------------------------------------------------------- ---------------------------______„__...____._.._________;...__________-__.____-_-___----_..______..__._________.________.____-_..__-.-_---_.___.____.._______________.__._____.___._____..____._._______.____________. 5V FINALINSPECTION BY:------ !— ��-"/'--"--%"-----------------•-•---._ Date----- ---- ------------------------------------- ------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street I 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9---2M ; Revised-W-2100