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Permit No.,.,�1`4___ APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) 1� Date Issued Applica4ion 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-----------------------2-316---I ----•-------------------------------------------------------- Owner's Name-------------_-------Cr_hSZ'I-es---R__-Ur-bani--------------------------------- -------------------------------- -------- Phonii—Q-3-66-42---•-------- Address----•---------------------------- Zb HackberrY.-_Street, City------------------------._..... -------------------------------------- y � Contractor's Name-----------------D,A.-_Parr ish-4--Sons-,--_-Inc_*---------------------------------------------.--..__ Phone_H© ------= Installation will serve: Residence)] Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __I___ Number of bedrooms :2___ Number of baths _1__ Lot size --------_____60-1---X---12 --------------------- Water Supply: Public system ® Community system ❑ Private ❑ Depth to Water Table -5o tft_ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ] 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--_______--____--_--____________-__-______-_____-� ❑Exis. No, of compartments---------------- ------Size--------------------------------Liquid depth--------------------------Capacity----------------------- Disposal Field: Distance from nearest well------------------ from foundation--------------------Distance to nearest lot line----.-------___. W E]ExJ.s. Number of lines------------------------------ ---Length of each line-----------------------------_.Width of french----------------------------------- Type of filter material-________________________Depth of filter material-----------------------Total length______-________________________________- Seepage Pit: Distance to nearest wellNonP-----------Distance from foundation_2P......... Distance to nearest lot line2.r?............ Ix Number of pits---.-,__.OIIe-----Lining material_BTiCk_-----.Siz6: Diameter33—n 8_ p ' p_1___. - *--.De tr�--- ---------------------- Cesspool: Distance from nearest well---------_-------Distance from foundation--------------------Lining material------------ ___----_-__----- [� Size: Diameter---------------------------- ---------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-__________________________________-_-__-_--_Distance from nearest building______-___________________-__-_-_______. ❑ Distance to nearest lot kne------------------------- ---------------------------------------------"--------------------------------------------------------- Remodeling and/or repairing (describe)_-------------------------------Addtoral dra� g@ ----------------------------------------•----------------------------•-•--------------•-•------•---------------------•----------------------------------------•--------------------------------------- I hereby certify that I have prepared this application and +hat 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. Parrish & Sosn� Inc, Owner and/or Contractor) (Signed) ---•------------------------------- { / ) Miles A. Parrish !' Ti+le-_--__Pres. -- ---- -- ----------- - 6 -L ) -- (Plot plan, showing size of lot, location of system"in relation to wells, b' (dings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONL APPLICATION ACCEPTED BY---- ------------------------------------------- DATE------------------- -.. --------- - DATE----------------•-- � -----•------------------------- REViEWED BY------------------------------ ------ --------- - --- - -------�----------------------------------- ----- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------•-----------------------• DATE------------------------------------------------------------- Alterationsand/or recommendations:--------------------------------------------•.---------------------------------------------------------------------------------------- --------------------- ---------•---------------------------•---------- -•--•------- ------------------------- ---------•-••------------------------------------------------------•-----------------------•--------•---------------- --------------------------------------- ------- •---•--------- - ---------------------------------------------------------------------------------------------- ----------------------- FINAL INSPECTION BY------------------------------------------'"''-----� __ Date--------- / ---------f- I------••------- ------------------------- 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-9-2 M1 Revised W-210D