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APPLICATION FOR SANITATION PERMIT Permit No- ------ ----- ------- s' (Complete in Duplicate) s' Date Issued .__ _-.71�.� i Application is hereby made to the San Joaquin Loftal Health District for a permit to construct and install the work herein described. This application is made in compliance with Coundinance No. 549. 1 1b ar ent Ave; Stockton JOB ADDRESS AND LOCATION y---------------------g----------------------------------------- ------------------------ -- --------------------------- ---------- Owner's Name--------------------- -------------------------- -- ---- --E. J. SALZSIEDLER 4-_-4040 -- --------------- -------------------------------------------- Phone------------------------------------ Address--------'--------•-•-____-- 12C, E. Noble ------------------------------------------------- H-------------•----------------------------------------------------------------------- 7 -------99667------------- Contractor's Name_______________________________-__ PARR ISH INC. ------- --•--------------------------------- -- -- - •- -- ----------------------------------•--- Phone----------------------------------- Installation ---------------• • --------------- Installation will serve: Residence & Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ t t ' Number of living units: 1____ Number of bedrooms z_____ Number of baths _1____ Lot size ___50_____X_9�___________________________ { 35t ' Water Supply: Public system K] Community,system E]_Private ❑ 'Depth to Water„Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ Noalg New Construction: Yes ] No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: Septic Tank: p Distance from earest well-_A________._. _Dlsta c fro dation__-_.-_-.------------ _ No septic tank or cesspool permitted if public sewer is available within 200 feet.] None 5 10 T CC :Briclt - �P -- ----'Material-------=--------------------- ----------------- P No. of compartments ._ _ -- "� z 900 Gals P Size p Liquid depths - Capacity - ------f d e t t Disposal Field: Distance from nearest well--None _Distance from founds .Q Distance to nearest lini, p 1 _ 1� t ii 11---Dia ] Number of lines-------- Length.,of each line __ n.____Y..____._.Width of trench _-__t._______ _ kales Type of filter material_1q��___xk:__.__Depth of.filter material _________._Total length___.__ ' ___ X��1te . See a e Pit: Distance to nearest well_-__Nflne__ Distance from foundation__ld_______. ..Distance to nearest l j} rie---- R___.__��_ 2 ' Number of pits-------_-�r------------Lining materialCC...BI'1Gksize: Diameter-----33 ...___.__.:Depth-------------------,;-----_--_�_ Cesspool: Distance from nearest well-________________Distance from foundation...-- -----______..Lining material--------------2_.._._---__.__.______- Size: Diameter--------------------------- ---.Depth ------------------------ ------Liquid Capacity ---------gals. ► ; Privy: Distance from nearest well____________________-'_a.-.------------------------Distance from nearest building---------------------------------------- ❑ Distance to nearest'lot line----------------------------~------------------:------------------------------- -------------------------------------------------------------- # r Remodeling and/or repairing (describe):--------.----------------------------------------- "----` ------------------------- ---------------------------------------------------------------------------------------------------------------t---------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------- --------•--------------------------------------------•------••---------------------------------------------------------------------- ____________________________________________________________________________________________________________________________________________________________•____-____-_______________________-____________________________.._ 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. PARR ISH INC. (Signed)--------------------------• -• ------------------ -•-------- {� Contractor) By;-------------------------------------•-•--•--•-------------- ------ -' --- --- ----- {Title) Estlm'tor (Plot plan, showing size of lot, location of sy em - relation to wells, b dings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- -----------------=--- --- ------------� --yy� Lk DATE-------------1l-- - `j�� REVIEWED BY Ll-- ------------------------------------- -- DATE----- --------- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------1----------- DATE--------------------- and/or recommendations----------------------------------------- ------ -----------------------•---------••-------------------------.-.--•----•--- ---------------------------•------ --•-----------------------•------------------------------•••----------•---------------------------------------•••---------------------"-......_....-----------------------------------•-----------------------••-----... -----•-------•----------------------------------------------------------------- ------------------------------------------ ------------------------------•-----•-••----------------•---•---------•-•----•-•------------ I --------------------------------- ----- ----------------------•--------------------------------------------•------ --------------------------•--------- ------...---------------•---------------------------------------- FINAL INSPECTION $Y:. a �` Date- ° ` F ` � --fit.•--------' - E ------- 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 I0-52 Revised W-2100