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APPLICATION ,FOR SANITATION PERMIT (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. JOB ADDRESS AND LOCAT[O ---------------------- 2?�' E' �r N- eet - stockton--------------------------------------------- Justj: Rogers 3— :O5 -------------- Owner s Name----- --------------------------------------------------------------------------- ------------------- Phone---------------- Address------•• ----------------------------------------- ?___E.---AdamB ►c3tY'eet-•--- -------------------- D.- - PARR 3H_ & SOYiS I G a---------------- Phone__9 n9 z---_----------- Contractor's Name-------------------------- A' x Installation will serve: Residence:K] Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [I Number of living units: -M Number of bedrooms3] Number of baths 1] Lot size--------_-_-------- Water Supply: Public system [Z Community system ❑ Private ❑ j 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.) m foundation_2C_r_ 3Alat n- l -------- -NIQ Septic Tank: Distance from nearest weILHD11e___.Distance ro-- � SJ--11 ___ b ___ ------- No. of compartments--------2---------- ---Capacity---- ---M---------- ize -- -- uid de ----------- Cesspool: Distance from nearest well --_.__Distance from foundation------------------ -Lining material-_______________-________.___-_ ❑ Size: Diameter--------------------------------------Depth--------------------------------------------------- Privy- ------------ -----------------------------Privy: Distance from nearest well------------------------------------------------------------Distance from nearest building------------------------------------------ ❑ Distance to nearest lot line____-___._____________________________________ Seepage Pit: Distance to nearest weIINQ 1P--______-_Distan�c+e from foundatson__l�t_________DisXance to nearest lot -i�e___�'�______-_ Number of pits-__---- materiaPP-__PTUkSize: Diameter---- X1 ------------------------------- 1xx Field: Distance from nearest well_N4n9_-_-Distance from foundation__12_:----------- to nearest lot line t-----_ 2-4" Number of lines_________________ ---------- a' --- -- -----Lep Length of each line-----�Q------II- --------Width of trench----------------------- Type of filter material__-l �s___R ----De Depth of filter material_____18____-__.___- Neti�-- -in st allat ion•----- ----------------------------------------------------•---------------------- Remodeling and/or repairing (describe______________ --------------------------------------------------- ------------------------- -------------------------------------- ------------------------------------------------------------------•---------- I hereby certify that I have prepared this application and that 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• PARRTSH &--SODS INC- - 4 - WContrac ) for (Signed)---------- - ---•-,- ¢fEstimator By:-- �t• _ -------------------------------- - ---------------------- --------------- -------)Title)-------------------------- ------------------- -------- -- (Plot plans, s owing size of lot, tbcation of system in relation to wells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------- /W ----------------------------------------- ------ DATE- - ----- ------------ REVIEWEDBY-------------------------------- ---- ---------- ----------------- DATE__ �_ �G � BUILDING PERMIT ISSUED. --- ----------- ------------------------ DATE Alterations and/or recommendations:_______ -- -----------•--------------------------------------- ---------- ---------------------------------- ----------------------------------------'-r-----------•- -------------------------- .y Date FINAL INSPECTION BY:----------W V_-)--- ------------------------------ PERMIT No---1'Q0__ ------- ISSUED---/6----- --------- } / Date---------------1-0...... -- -)------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9.50 W=1639