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APPLICATION FOR SANITATION PERMIT Permit 6o. _6e (Complete in Duplicate) Date issued Applica4,ion 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----------738--- o,---Wags_er,__.St_Q_ckton---------- ----------------------•------------------------------------------------- Owner's Name--------------------------------------------Mr•---Xs____Quink---------------------- ------------------------ -- Phone..-_.EQ...S8-13-6------- Address---------------------------------------------------------Sade----------._....---......... Contractor's Name------------------•-•-------•---- ••Pc1rT'--Sh--&----SO�i,S 1----T=--------------------------------•--------- __ Phone-----H!5_696W...... Installation will serve: Residence ZX Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ 1 Y Number of living units: ___1-__ Number of bedrooms __3_._ Number of baths .1-*. Lot size ------65 ----X__J.50 t Water Supply:. Public system ❑ Community system ❑ Private X; Depth to Water Table __1+0 ft. Character of soil to a depth of 3 fee+: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe M Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ 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------------_---.----_---.------_-_-_-_______--. Ex4 t ing No. of compartments--------------------.._-Size--------------------------- ---Liquid depth.-------------------------Capacity----------------------- Disposal Field: Distance from nearest well_________________Distance from foundation-------------------.Distance to nearest lot line--__-----__---.- Ex-Qting Number of lines-----------------------------------Length of each line------------------------------Width of trench.-------------------------------_-- Type of filter material-------------------------Depth of filter material-----------------------Total length--------- __.------_----__-----_- t Seepage Pit: Distance to nearest well--------100t__Dis+a e from f, ndation-----101.._.__..Distance to.nearest lot line----5t W Number of ,fs.__.__1--__---_---Linin mat ial-_rick. _Size: Diameter--__ �$ p� 9 -- 33.............Depth-----2-��-t--------------------pQ Cesspool: Distance from nearest well--------_________Dis nce fro undation--------------------Lining material------------------------__-_-__------. ❑ Size: Diameter------------ -------- ----- ----------Depth------------------------------- -----.---------------Liquid Capacity----------------------------gals. N Privy: Distance from nearest well.............------------------------------------Distance from nearest building-----------------------_--_.___-___-_-. ❑ Distance to nearest lot line------ .------------------------------------ •--------------------------------------------------------------------- Remodelingand/or repairing,(describe);------- ------•------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------ ------------------------------•-------------- µi-----------------------------•-------------------------..---------------------•-.----- -- ------------------------- - ------ -- ------ - -- - - -•----------------------------------- ----------------------------------- I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations oft-he San JoaquinL cal Health District, 9 (Signed)---------------PARRISH .&- SONS INC -------- -( � Contractor) By:-------------------- �->� - -,-------------------(Title)----Ess-t.3ms_t_or--------------- ---------- --------•--�-•----------------------------=-------- (Plot plan, showing size of lot, location of sys a in relation to wells, bu'dings, efc., can be placed on reverse side). FOR DEPARTMENT 6SE ONLY APPLICATIONACCEPTED BY------------------ -------cZ -- ------------- -- ---------------------------------------- DATE--- -----IZ --------------------------------------------- REVIEWED ---•- ---------------- REVIEWEDBY----------------------- -. ------- --------------- -------- -------------------------------- --------- DATE-------- -----------------•-------------------------------- BUILDING PERMIT ISSUED---------------------------------- ---------------------------------------------------- DATE-------------- -- - - Alterations and/or r.commendations:------------------------- �-------------------.--........... ------------------•----------------- ..------------------------------ -------------------------- ----=--•----------------•-•- ---------- -�--- �------ j �� ---- < -------------------- --------- ------= A_.- ------J-�`---- - -v�-`-- -- ---------------------- --------------- -------------------------------------- ---------- ------ --- ---------------------:----------------------------------------------------------------------------------------------- ----------------------------- --- . FINAL INSPECTION BY:--------- --- ---------- Date..... ---------------—--------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 014 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 145446 ATWOOD 12-54