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� 5-q APPLICATION EOR SANITATION PERMIT (Complete in Duplicate) w Y 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---------16V--Stanford--Stre-et-1,--- St_o_c_kt_o_n----------------------------------------------------- ------------- Owner's Name---------- G`' ,_A' Shackelford Phone 5—503 --------------- Address--------------x--6 2.7_ - t;>,for-d--------------------------------------------------------------------------------------------------------=------------------------------------------------ Contractor's Name--- D`- A, PA- RR15H & SONS.,----I- N--C- , ---------------- Phone----2... --------------- -------------------------------------- Installation will serve: Residence [3 Apartment House ❑ Commercial [] Trailer Court ❑ Motel ❑ Other ❑ Number of living units: 1] Number of bedrooms (3] Number of baths [I Lot --------------------------- Water Supply: Public system [R Community system ❑ Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel E] Sandy Loam E] Clay Loam ❑ Clay ❑ Adobe,g 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__XQ1_Q:_Distance from foundation----2.__-_______.Material_ReC�TvOOCI,_------------------------- No. of compartments-----------2-------------Capactty---a�a C -----Size---7-f-_X3t1-_N-5+-1 ---Liquid depth-------54-- ------------ Cesspool: Distance from nearest well-----------------Distance from fou ndation--------------------Lining material-___-_---____________________-_ ❑ Size: Diameter--------------------------------------Depth--------------------=------------------------------- Privy: Distance from nearest well-------------------------------------------------Distance from nearest building---------------------------._____________- ❑ Distance to nearest lot line------------------------------------------------ t�0rr Seepage Pit: Distance to nearest well--j9�je--------Distance from foundation_____ ___ ------Distance to nearest lot line_.a-2________- { i Number of pits--------1-----------Lining matenal_ Size: Diameter--t__3 _____ ---Depth--- Disposal Field: . Distance from nearest; well_________________Distance from foundation________---________Distance to nearest lot line...___________ El Number of lines-----------------------------------Length of each line------------------------------Width of'trench----------------------------------- Type of filter material-------------------------Depth of filter material--------_______________ Remodeling and/or repairing (describe):_--____Rer?jodel nv_ exists 7pr-_-septic__-and insta1l_i ng_- T!p.j ._--_--. ----------•--------------------------------------•------------------------------------------------------------------------------------------------------------------------------------------------------------------------- A 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= PARRI SH & SOI1 S, 111C; _ .- ( r"pian ,�or'Oontractor) ( - ----- - --- - - ------------------------------------------------------------------------- -- By=---------------------------------------------------------------------------------------------------------------------------------(Title)---STUAT 131 ; ------•------------------------ (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------- -- •. ---------------- REVIEWEDBY---------------------------------------------------------------- --- ---- - ----------------------------- DATE------------------------------------------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------- Alterations and/or recommendations:------------------------------------------------- ---•---------------------------------------- -•-------------•-----------------•------------------ --------------------------------------------------------------------------------------------...---------------- -----------------------------•------------ r ----------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------•---------------------------------- -- - - ------------------------------ ----------------------------------------------------------------=--------------------------------------------------------------------------------------------------------------- # , --------------------------------------------------------------------------------------------------------------------------------------------------------------------- -P-E-,M-1 T --------------- PERMIT No------------------ ------ ISSUED------------------------------------------(Date) FINAL INSPECTION BY:-------- H----------------------------------- �- - --- O �� Date-----------------a` - - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W=1639