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3 APPLICATION FOR SANITATION PERMIT x (Complete in Duplicate) 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. 3 :�c 4� s7 (East side of Glenn Sto JOB ADDRESS AND LOCATION--- r_own_ flat---t_op__house__-an__corner__of___Glenn__8treet__&__Swa n__Rd. +4 Owner's Name-------------------------- -------- NOMI@ZZini--COnS ruction ComDanu-------------------------- Phone------9.'-9-57�'------------- t Address------------------------------------------------ - 939--Marengo__RPAda---Stockton--------------------------------------------------I---------------r--- Contractor's Name............._----------------D. - A.._ Parrish & Sons. Inc. "- Phone------9 - 607_---__------ - -- --- - Installation will serve: Residence IK Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: [, Number of bedrooms E2_ Number of baths ID Lot size_---__-6Q1. .j,a!------------------------------- Water Supply: Public system.❑ Community system [Z Private ❑ r 1 Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Lbam❑ 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 Distance from foundation--- -Ot_-"___-.Material- t!__C---BI' Ck----------------', No. of compartments------�--•--_----------_Capacity---$00---G---Size--5-61tdepth x��tt��3#Liquid ------5� ---------- Cesspool: d „R.. Distance from nearest well_________________Distance from foundation--_.-------------_.Lining material-_--_--__-----------_---------_----- ❑ Size: Diameter------------------------ --Depth---------------------------------------------------- _--_t - Distance from nearest building --------------A Privy: Distance from nearest well----------------------------------- _ -_-_-- g-_------------------__---- ❑ 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-------------------------------I . ,Disposal Field: Distance from nearest L__NQnLe--Distance from foundati n---2Q-=------- Distance to nearest lot line_-_-5------I Number of lines________ _____f_-_-_-_----.__Length of each line-_ th of trench-------- -7-_-______- 'i Type of filter material_ Depth of filter materi _:--:--_---'--------- 18't - Remodeling and/or repairing (describe):----------New---installation____________- -, -----------------------------------------------------------------------� ----------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------- •------------ --- h ---------------------------------------------------------------------------•--------------------------------.--------------.------------- ?------------------------- -------•-------------------------------- �� - ----------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------- 1 hereby certify that I have prepared this application and that the work wil be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)--------- --- A I- SANS-e----QVC-•-------------------0----------------P-------------A-------- ------+--------- Contractor) By:-------- - `'"` ------------ - ------- -----------------------------------(Title)----a$-�-i a -Qr-------------------------- (Plot plans, sho i g size of lot, location of sy em in relation to wells, buildings, etc., must be filed with this applicafion�. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------- _��----------------------------- ------------------------ DATE---�...��= /----------------------------- REVIEWED BY------------------------------------------------- -- DATE---------------------------- --------------------------- BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE---------------------------------- ------------------------- Alterations and/or recommendations------------------------------------------------------------------------------------------------------------------------ -- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ =----------------------------------------------------------------------------------------------------------------------------------------------------•-------------------------------------------------------------------- ----------------------------- ------------------------------------------------------------------------------------ ---------- ------------ � 3 ,X PERMIT No.---- _-- ---------- ISSUED------- ------------------------- ------(Date) FINAL INSPECTION BY:_-________-->------ - - ) Date -------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9750 W-1639