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• APPLICATION FOR SANITATION PERMIT Permit No-_ -.!J___Y in Duplicate) -'(Complete P � Date Issued 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. 549, JOB ADDRESS AND LOCATION------------ Y25___gan__Mateo_ Avenue -- --------------------------------------------------------------------------------------------- Owner's Name Nelson E.___.St© r1]1------------------------------------------ ------ Phone---4-204 - ---------------- Address----------•--•---------- SAmC ---------------- ---------------------------------------------------------------------------------------------•----------------------------------= Contractor's Name------------------------------------—°---�« PARRISH---&--SONS------------------9-----INC,--------- ONS-s---INC------------------------------- Phone---9!-960 Installation will serve: .Residence [ Apartment House ❑ Commercial E] Trailer Court ❑ Motel ❑ Other ❑ i Number of living units: ---- Number Number of bedrooms ----?-_ Number of baths --k--" Lot size -- __ 0 ______________________ _ Water Supply: Public system 99 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 QI Hardpan ❑IF , Previous Application Made: Yes ❑ Nom New 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 nearest well-----------------Distance from foundation--------------------Material____---_---___________-__--____---_-______--__--. ExIgting No. of compartments--------------------------Size--------,-----------------------Liquid depth--------------------------Capacity----------------------- Disposal Field: Distance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line_____--_--_______ EXJ[Rtiing Number of lines----------------------------------Length of each line------------------------------Width of trench----------------------------_----- Type of filter material-------------------------Depth of .filter material----------- -----------Total length______-_________________--.____-________ { Seepage Pit:. Distance to nearest well_None Distance . fo nd tion2 Q-.Plug lot 1jd%rT 33�nce to nearest loot line:_______.-____- Number of pits-------_��---------_-Lining material------------- ------ e. Diameter_-__._.___-___________-.Depth---3_----------------- ------ Cesspool: Distance from nearest weil-----------------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-------------------- i Remodeling and/or repairing (describe): -------------------------------------------•--------------------------------------•-----------•------------------------------.. ----------- ----•-------------------•--------- ---------------------------•-------•--------------------------•------------------------------------ •--------------------------------------•---•----------•-----------------•----------------------------------------------- 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. [Si ned D A• P SH & SONS INC* • • g )----- #- --------P------------------------------------------------------------------------------- [ � Contractor) _ Estimator gY� ------------[Title) t (Plot plan, sh ing size of to#, to do of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- H -_ ------------------------------- DATE---------------------- REVIEWED BY --------- ------------------------------ DATE_c�-�'s-- -- ---� S7 r ... BUILDING PERMIT ISSUED------. .. -------------- ---------------------------------------------------------•-- DATE Alterations and/or recommendations:-------------------------- ---------- -------------------------------------------------------------- ---------------------------------- ----------------------•----•------ ----------------------- ------------------------------------------------------------ --------------- --------------------------------- FINAL-I -----------------------FINAL-INSPECTION BY:--.ell/ Y:--.el -- --------- Date_ ---------------Z--"�� SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 8-51 Revised W-2100