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APPLICATION FOR SANITATION PERMIT Permit No. .. _7' ._ (Complete in Duplicate) I f 3 „, Date Issued _ ______. Applica+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. 1759 West Hazelton Street, Sto6kton JOBADDRESS AND LOCATION------------------------ - -------------------------•----------------------------------------------------------- --••-----------•--•--•-•-•------------ Owner's Name_________________ ROber-t W€tgne-r 7778b7 -- - ------- --•------------ Phon ” 3.43 E. Weber Avenue Address ---- ---------- -- --- ---•---- Contractor's Name--------------------------p�''RRISH IN C. 97?9 _07 - -----------•----------------------•------------------------------------------------------ Phone Installation will serve: Residence [N Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ . > " 60f X 1201 Number of living units:'-- ---. Number of bedrooms _____'2__ Number of baths '._____ Lot siie_____________________________________________ __:-__-______ Water Supply: Public system @L.Community system ❑ Private ❑ Depth to Water Table 30tft. _ Character of soil to a depth of 3 feet: Sand [] Gravel ❑ Sandy Loam [❑ Clay Loam ❑ Clay ❑ Adobe[Hardpan ❑ # Replacement Previous Application Made: Yes ❑ No jgL New Construction: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 102 CC Septic Tank: Distance from nearest well__-N©n�'_.Distant rom undation__________________.Matey i I-_-__-_--__B�`f.G No. of compartments_____-2- Size.__ _� h- IDLi uid-de th__..__-�b�______-_-Ca capacity BOQ ----- 630----d-eep q � I p tY Disposal Field: Distance from neare wO_NOnC___._..Distance from foundat n¢___l0______-.-.Distance to nearest o� lines_______.___.. [ Number of iines___.___ _____ -------- -_ Length of each line------------ Width of trench_._2� ........................ Type of filter material--.l�n-__F{k___-Depth of filter material__1--p_____________Totallength___---------------------------------------- Seepage S�__-_-_-__--________-_-____---- See a ePit: DistanceWto nearest iyell__N __.___.Distance f{�m f�� at' n_1©_._._____...Q nce to nearest Io�ijP -_-�_.__.______ P 9 aL ��++ J J.. V g Number of its---------------------Linin material___________._.__. INX p g Diameter ..Depth f Cesspool: Distance from nearest well-----------------Distance from foundation....------ ----.lining material------------_-.---_-__--.---__-____-_ ❑ Size: Diameter--------------------"-----------------Depth----•----------------------------------------------Liquid Capacity----------------------------gals. Priv Distance from nearest well________________________ Distance from nearest buildingv - Y' ❑ - Distance to nearest lot line-------------------------------------------------------------............. -•------------------------------------------------------------- Remode€ing and/or repairing (describe):---------------------------- -----------------•------------------ ------------•---------------------------•---•------------------------------------------------------------------------------------------------------------------------------------------ I hereby certify that I have prepared this application and that a work will be done in accordance with San Joaquin County ordinances, State laws, and rules and re ulations of the San Joaq n Local Health District. PARRISH INC (Signed)-- --------------------------------- ---------- -------------- -----------•-- -- -------------•---•------------------------------•----_- - ----- 13XXXX r Contractor By:......••------------------------------- ---------- -------- --------------- -------- ..--------------------(Title)--- ------- - (Plot plan, showing size of lot ocation f system in relation to we , b ildings, etc., can be placed on reverse side). FOR DEPART ENT USE ONLY APPLICATION ACCEPTED BY---- - _ - DATE >—----------------- REVIEWED BY------------------------------- - -- ------------------- DATE---- c.� �C BUILDINGPERMIT ISSUED---------- ----- ---- ---�------------- ---------------------------------------------------------- DATE-------•---------------------- Alterationsand/or recommend ations-----------------------------------------------------------r----------------------------------------------------------------------------------------------------- --------------- t -------------------------------------------- ----------I--------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ -------•----------------------•------------- ---------------------------------------------------------------•- ----------------------------------------------------------------------------.------ ---------------- --------------- --•------------ _ FINAL INSPECTION BY ----- SAN ✓ ----- 3 Date 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 C ES-9-2M Revised W-21oo'#