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APPLICATION FOR SANITATION PERMIT F i (Complete in_Duplicate) _ i 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. s JOB ADDRESS AND LOCATION-------------------------------4 -5-_N.. ---Shae_ta- Ave. Stockton Owner's Name------------------------------G`eO Y' E---ECjen ` 1, : Phone 3^^2 -------- ------------ - --------- --------------.--: --------- Address--------------------------___----------4I-5._hd. Shasta, Ave. StoCk ton _-Cal. -- ------------------ ---------------------------------------------- + Contractor's Name--------------3) A. arr1 8h & Song �nG.• A 8-8597 �- - ---------- ----------=-`, --- Phone----------------------------------- Installation - -will serve: Residence [N Apartment House ❑ Commercial ❑ Trailer Court ❑R Motel ❑ ;Other ❑ Number of living units:)t Number of bedrooms ] Number of baths [l] Lot size__-_--__-__x2J�__X_ X50' f E:et Water Supply: Public system ❑ Community system ❑ Private ► t t o Character of soil to a depth of 3 feet: .Sand [] Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [N; Hard pan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 1260 feet.)) 1 Septic Tank: Distance from nearest well-�Q___----__Distance' frorri foun�lation___3 _& 5a zral.- gpn_�___Bl�LB. p (j tVP 90 0 G 1------ --------- ® No. of compartments Capacity = Size :----------------------- Alquid depth �r - Cesspool: Distance from nearest well---------------- Distance from foundation-__:_-- ------------Lining material F----_-.____i____---.__ ❑ Size: Diameter--------------------------------------Depth-- •---------�;` ----------------------- Privy: Distance from nearest welt _______________________gyp;stance ifrom,xnearest-building-_-.-___-----,°,_''__ ❑ Distance to nearest lot line------------------------------------ _,- Seepage Pit: Distance to nearest well------------ ------Distance from foundation `. '-..Distance to nearest lot line_-------.-__-_-- ❑ Number of pits--y------------------Lining material-----------------------Size: Diameter-----------------------.Depth-------------------- ' Disposal Field: Distance from nearest well_-_94___-_-_.Distance from foundation--_ __--- J - ----.Distance to neared lif. line Nurriber of lines------------ _---------Length of each line----100'!---------------Width of trench-.________------_-------_-- ----_-- Type of filter material-- ...--_r'�CkDepth of filter material_--12'x_'_-:,_-_-- q Remodeling and/or repairing (describe)---------------ggq_p p to S StGIII renla e�nent ------------------ ----------------•------------------------------------- -__[•__yy__•.--------_-_-•-----------•_-----•---------------...___-_--•-_----__-_• ------------------------------•-------------------------------------------------------------------------------------------------------------------•=---------- -------•--•--'--3-•---- ------ 1 I hereby certify that I have prepared this application and that the work will be done i- accordance with San Joaquin County.. ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. 3 ! (Signed)----------------D_.A......ParrlBH__8c_ ;�on�3-�----lncx--------------- '-----•----(Owner and/or Contractor) --------------------------------------------- BY__---_-------------- Miles A' Parrish (Title) P dent • z'esf (Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------- ------------------ - - -------------------------------- ------ DATE �O� 3os Sd REVIEWED BY - - ------------------------- DATE BUILDING -- --- ---------- PERMIT ISSUED ---------------------------------------------------- --------------------------------- DATE--- - _ Alterations and/or recommendations--------------_-___-_ ------------ •� ------• -----------------•----------- -_ ---------------------------------------------------•-•-------•-•------•---------------------------------- - - PERMIT No._-.--- _L_---__ ISSUED �, 5.(� • ---- - � - •-___-- ------(Date) FINAL INSPECTION BY:---------�_'1------------- ------------------------------ Date---------------- f G=T3 --------------- ----------- SAN JOAQUIN LOCAL HEALTH-DISTRICT 130 South American Street Stockton, California - ES-9-2M 9-50 W-1639