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� APPLICATION FOR SANITATION PERMIT w (Complete in Duplicate) Application is hereby made to the San Joaquin Local HealthDistrict for a permit to construct and mall the work herein described. This application is made in compliance with County Ordinance No. 549. 11 JOB ADDRESS AND LOCATION------------ �__�9�_--Wags•��_.AYE.t�-t�.e�----Stock�_pn----------------------------- Owner's Name_ - ------------ -----------------LUCille___A.- -Nelann---------------- ---- Address Phone - ------ ---------•-----------------------319--S-a.---ala ne-r--Are g nue--------------------------- -------------------------------------------------------------- antractor's Name_____"___.""-_A A,----PARRTSH-""&_"SONS__"INC;;-_-"_____________ _________________________ ____ ------ Phone------ _ ----------- Installation will serve: Residence I�- Apartment House ❑ Commercial �fl Number of livingunits: ❑ Trailer Court ❑ Motel ❑ Other ❑ Q Number of bedrooms g] Number of baths t Water Supply: [�, . Lot size-------50,--- - PP Y: Publics stem . Y ❑ Community system ❑ Private Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ 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_________________Distance from foundation--------------------Material -________________ \ ❑ No. of compartments------------------- \ CepacitY-----------------------Size--------------------------------Liquid depth--------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material--------------------- ❑ Size: Diameter--------------------- ---------------Depth----------------------------- ----------------- Privy: Distance from nearest well___________________________ ___________________Distance from nearest buildin ❑ Distance to nearest loft line------------------------------------------------ 9 ------------ Seepage Pit: Distance to nearest well-----------------------Distance from foundation___-_ _ ______________Distance to nearest lot line___-____-_"______ Number of Pits-----_----------------Lining material_---------------------Size: Diameter------------------------ -Disposal Field: Distance from newest well------3-01–Distance from foundation_." Depth ________-_-----_-___" "" Number of lines---__-I--------------------------s �� - _______-Distance to nearest lot line_____�t"-_ Length of each line__-_______401-----------Width of trench--------21tt-'--,"- Type of filter material____1V__R$__Depth of filter material_-___-181:--______ -Remodeling and/or repairing (describe)---------------►SUPPlement t @_:j5t1n dr -----------------------------------------------------------'-------- -------------------------------- ------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, laws, and rules and regul s o e San Joaquin Local Health District, 4 (Signed)------- •_ INC --------- ----------------•-------------------(moi ic��_Contractor) y (Plot pl ns, sh g saeof lot, location of s ste m r lation to well------------------- --- --------(Title)---- st-Lmtor_-----r--= 1 i s, buildings, etc., must be filed with this application). I FOR DEPARTMENT USE ONLY f APPLICATION ACCEPTED BY_._ , REVIEWED BY -------------------------------------------------------- --------------------- ---------- - 4 _------ --- -- -- DATE------------- ---- ---------------------------- -------------------------------- DATE---------- - -------------------- UILDING PERMIT ISSUED_______ ____ -------_----------------------------- --- _-------------------------- ------------ ----------------------- DATE - ------------------------------------------ Aterations and/or recommendations:__-_'__-_______ ------------ ------------------------ ----------- ---------------------------- --------- -------------------------------------------- ----------------------------- I ----------------•--------------- _ ---------------- PERMIT No.----- -I'l---------- ISSUED-----5--`-`2 -5 ------(Date) FINAL INSPECTION BY:----------------�,d _/---Yj } _ -------- Date : SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street ES-9-2M 9-50 W=1639 Stockton, California