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APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Application is hereby made to the San Joaquin Local Heal fh lNoc549r a permit to construct and install the Work herein described, This application is made in compliance with County Ordinance JOB ADDRESS AND LOCATION_}___.---- 3Q9----B 1k ',Pearl Ave. Owner's Name--------------------------------------------� .----L-iA-C3- 8 UI1derTr*QOC�.- ---Dr.--- -- --- - - - ---------------- --------------------- Phone---- �Y�� Address ----- 315 Pearl Ave, ---------------- IncContractor's Name--------•-------------- �.A. Pa�'r18h & �Un$, • ---------------- Installation will serve: Residence ] Apartment House ❑ Commercial Phone--- ---- of livingunits: ❑ Trailer Court ❑ Motel ❑ Other ❑ �.,�. I 'Number of bedrooms Number of baths ❑ Lot size-__/__ Wafer Supply: Publics stem `� --------------- Y ❑ Community system ❑ Private �] Character of soil to a depth of 3 feet: Sand ❑ Grave! ❑ Sandy Loam ❑ Clay Loam ❑ Clay "U ❑ Adobe� 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---]a---------Distance from foundation____ 10--1 Can B1ks, Tti1r0 �ferial- I No. of compartments Capacity_�OC-----------.---Size-��--&-� --•---P'E7 uid depth----- "... ---- . E Cesspool: Distance from nearest well-----------------Distance from foundation__-_--_-- -_--_____Lining material-___--_-_____- ---_ ❑ Size: Diameter--------------------------------------Depth ----------------Priv - - -------- Y: Distance from nearest well_______________________ Distance from nearest building------------------ ----- ❑ Distance to nearest lot line__________________________ _ _-_-_____---__ Seepage Pit: Distance to nearest well----------------------Distance from foundation___--__------------- F1Number of pits______________________Lining material__ .Distance to nearest lot line__-..--____.-____ --------------------Size: Diameter-----------------------Depfh--------------------------------- Dispoosal Field: Distance from nearest well 4Q --------Distance from found do 2Q � t CJ Number of lines_________U1C -___ Distance to nearestgtline_ _____________ ----Length of each hne'��_""�7"'377__ rte} Type of filter materia,______r'oCk pepth of filter material-_12ti-- _Width of french---------------------- Remodeling and/or repairing (describe):--.-------____ Ney S stem --------------------------- ------------------------------------- -------------- --------------------------------------------•------------------------------------------------------------------------------------------ -------- ------------------------•---------------------•-------- ------- 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 regulations of the San Joaquin Local Health District. (Signed)------------------ ---A"-.Parish &'Sons, Inc. ------- ---------- ---- -- -------- ---------•--- (Ow By:----------- � (Owner and/or Contractor) ___ ___P___r_resident (Plot plans, show i/S'.ze of lot, location of system in rela to wells, buildings, etc., mus} bee)il fed with this application):. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- 1_-V__-(------------------------`_ _ REVIEWED BY------------------------------------ I�-) DATE /z� �J----l�---------- BUILDING PERMIT ISSUED - -- ------------ ---------------------- DATE----------6�--^ l r -- -- -- ---------------- DATE -------- --------------------- Alterations and/or recommendations: ----------------------�� - - ------ ------------------------ ----------------- --------------------------- --------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------- PERMIT No-1j_y------------ ISSUED_ ------- ----------------------------------------------- / -l— 57� - ------(Date) FINAL INSPECTION BY:---- ' Date-------- j� --------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 9 ' 2M 9-50 W-1639 Stockton, California