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',• p APPLICATION FOR SANITATION PERMIT Permit No. -a___3---i'__I (Complete in Duplicate) �{ 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... 1911 E. 12th, Street,, Stockton - -- - ------------------ Owner's Name------------- Earl Yates None -------------•---••------•--- ------------------------------------------- ---------------- ---- Phone----�- --- --------- ---------------------------------- Address--------------------------••---- 1911 E' 12th. Stree - - ----------------------------------------------------•------------------------------------------- Contractor's Name------------------------------------ D-.--A`---PARRISH--`�--- SONS_-1...TNC*------------- -------------- Phone------9,960-7---------•- Installation will serve: ResidencM Apartment House ❑ Commercial E❑ Trailer Court E] Motel ElOther F-1Number of living units: _1---_ Number of bedrooms _---1_ Number of baths -1--- Lot size .50-_x85_--_ -------------------------------------- Water Supply: Public system [N Community system ❑ Private ❑ Depth to Water Table .------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam 0 Clay Loam [❑ Clay [J Adobe g Hardpan ❑ Previous Application Made: Yes ❑ No X' New Construction: Yes 2;( No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) N Septic Tank: Distance from nearest well---None Distanc from fn unc�ation--_1�*---.___. atrialCC �r'1C)E{ NZ Fj I� No. of compartments------2-----------------Size-_,5�---x-6------_Liquid depth-_____ .___-___-------Capacity_-800 a------- Disposal Field: Distance from nearest well__NOn -_.Distance from foundatipr� r] _ ------Distance to nearest I �i�e - ___---.� M Number of lines---------------- - �___-- _ Length of each ----- - Width of trench ---____--_____-----_------4 Type of filter material--lin Depth of filter material----18--_---____-_Total length_-_---7-5-1------------------------------ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------__--__ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth--------------------____------_-. Cesspool: Distance from nearest well--------------_-Distance from foundation------------------- Lining material-------------------------------- F Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity-- -------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----- El Distance to nearest lot Iine----------------- ------------------------------------------------------------------------------------------ Remodeling and/or repairing (describe):_-__New installation in Floyd Tract --------------------•------------------------------------------•--------------------------------------------•------------------- ------------------------ --- - - - -- - 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. D A. TSH & SONS, & SONS, INC. }�y t� (Signed)--- ------ ----------------------------------------------------- ------- ----- - -----(25;i tS ontractor) BY� --------- Title Estimator ------- ------ -- -------------- - ----------------------------- (Plot plan, wing size of lot, locati of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- ------- -- ----- ----------- __--------------- DATE REVIEWED BY--------------------------------- - DATE- BUILDING PERMIT ISSUED --------- DATE Alterations and/or recommendations:----------------------- ----------------------------------------------------------------------------------------- - ------------------- ------------------------ ------------------------------•-------------------------- ------- -- ----------------------- FINAL INSPECTION BY:---- Date / ------------------------------------------------- f r 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