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APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Application is"hereby made to the San Joaquin Local Health District for a permit to construct and install the work he described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION 1928 E. 12th* -S S - . -------------- ------------------ Phone-----3-1.661 ---- Owner's Name------JOh31---14'----��-.S�tr�.,�'-------- ---------- Address---------------------1-928 E-' 12th. Stree�--------------------------------------------------------------------------------------------------------------------------- ; D. A. PARRISH &__SQ1TS. INC-`------------- Phone- - 9'-9 0-;� Contractor's Name-------------------- -- ----------------- -- Installation will serve Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ r Number of living units: 11 Number of bedrooms ❑ Number of baths ❑ Lot ______________________________-__--__ Water Supply: Public system [N Community system ❑ Private ❑ c Character of soil to a depth of 3 feet: Sand ❑ Gravel El --Sandy Loam El Clay Loam El Clay ❑ Adobe ] Hardpan ❑ 't TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ' � arc. Blx Septic Tank: Distance from nearest well_s!flne....Distance from foundation____ �i� —.,Matrialq _}�------------C-onc-2-i-----------. 14 No. of compartments ----------------Ca Capacity ��Q =G� Size -- --------------- Squid depth-------5- ------------- pP tY----• ---- Cesspool: Distance from nearest well-----------------Distance from foundation-----.--------------Lining material------------------------------------- F-1 Size: Diameter-------------------------------------Depth--------------------- ----------------------------- N Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ El ---_---__- _---------------------.❑ Distance to nearest lot line________________________________________________ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line--__----_--__---_ ❑ Number of pits----------------------Lining material-.---------------------Size: Diameter-----------------------Depth--------------------------------- _ nearest well----__RP>1_Mstance from foundation--,-,-,,--__-__--.Distance to nearest lot line-----&_1------- Disposal Field: Distance from Number of lines----�''__�__--- Length of each line-___----._- .....::..:..:Width of trench-------:_._::-__------___ Type of filter material_- -=T_f1___Rk-----Depth of filter material----12'1------- Remodeling and/or repairing (describa):--- I---- Tl_,it ----'----------•-------------- ------------------------------ --------------------------------------------------------•-------------------------•------------------------------------------------------•-------------- -------------------•----------------------------------------------------------------------------------------------------------- 1 ------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------- 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 regulati�ons'oof the San Joaquin Local Health District. [Signed} D. A it'cc$'1' 5�1 o S_ Iri C. 4-------v------' [ e}l. I�r Contract ) �+ _._ --- ----- - --------------------- ESiim for Y. F JE' Z,r-tr----------------------------------------------------•-----------(Title)-_----------------------- --------------------------------- :I [Plot lans owing size of lot, location of sy j mii relation to wells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY 1t 1 APPLICATIONACCEPTED BY------------------------ J-- I------------------------------------------------------ DATE------ -------------------- REVIEWED BY-------------------------------------------------------------- ---------------------- ---------------------------------------- DATE-------- --------------------------------------------------- BUILDINGPERMIT ISSUED---•-------------------------------------------------------------------------------- ---------------- DATE----------------------------------------------- Alterations and/or recommendations-------------•------------------------------------------------------------------------•-------------------------------------------------------------------------- , ----- -----------•----------------•- -------------------------------•----------------------------------- --------------•----------------- �- ; 4r a °`-------Lay", R-------- j--S:-�'•-----------•------------------------------------------------------------ PERMIT No.-,2- - ISSUED /'- - _-5�----------[Date FINAL INSPECTION BY:-------- - ------------------ Date--- --------------------)-- -•--.�--�- --��-�---------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 30 South American Street Stockton, California E5--9-2M 9-50 W-1639