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APPLIC ATION FOR SANITATION PERMIT (Complete in Duplicate Joaquin Local Health District for a permit to construct and install the work herein described. Application is hereby made to the San with ; tp(±kt011 This application is made in compliance with County Ordinance No. 54 812.5_-Loper Sacramento- Road JOB ADDRESS AND LOCATION__ ---------------- JOB , --- - -- -- - - - - ----------- Phone---�"'�----- --- ---------- for Gi on --------------------- ----- - Tai - goad 3tocktoa --------------------------- Owner's Name--------------------- -- pt�er SaeraMento - - -- ' 9..9607 ---------- ; 8125-_ ' & SONS,, INC* . • Phone -------------------- Address------------------------ -----------�-------- Other ----------A-�---p-------------- - Motel ❑ ❑ Contractor's Name----------------------------•-s Commercial ❑ Trailer Court ❑ ' X Apartment House ❑ ----------------.- Installation will serve: Residence Number of bedrooms Number of baths ❑ Lot size--"1�------R-------------------- Number of living units: ] Private ® ' F ❑ Community system ❑ ❑ Cla Adobe [X Hardpan ❑ Water Supply: Public system � Character of soil to a depth of 3 feet: Sand ❑ Gravel El' Sandy Loam El Clay Loam Y R `- JJ TYPE OF INSTALLATION AND SPECIFICATIONS: ` V) (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Size---------------- Liquid depth Tank: -------------- Distance from nearest well-----------------Distance from foundation-_--_- -----Materia-------------------------------- SepticCapacity -- ---------- , ❑ No. of compartments-------------------------- l: Distance from nearest well-----------------DDistance t ace from foundation---------------------- cesspool'. ------ ---;---Lining materia----------- cesspoo - ❑ Size: Diameter........................................ -------- --------- ----,---- --"--- -----_"-- --- --"- --Distance from nearest building-------------------- Privy: Distance from nearest well"-__"-------------- ---- " ------------ ❑ Distance to nearest lot line-" ---- istance to nearest well--'---------- Distance from foundation--------------------Distance to nearest lot ine-------------_-- Seepage D Size: Diameter .................... ------------- ---.Depth-------------------------------- Pit: Number of pits__"----------------- Lining material___"------------ j0 1"------Distance to nearest lot ire"---- ----- ❑ 1 --.Distance from foundatign___" -. --- . . Disposal Field: Distance from nearest Well Length of each line- fl----- p-- Width of #Tench-------------------------------- Disposal ----�-------- ---� ------ In Number of lines--------------- 1�-_-------- Type of filter.....I l--1�_---�-----Depth of filter matertia-.--------- t �`�, p lament to expting draina � syr ------ -------------------------- ---- Remodelinq and/or repairing (describe):-__-.-"-_-- -------------- ---- ; ---------------------------------- -- -- ----- --- -------------- reb certify that 1 have prepared this spplicatioSan JoaauinhLocalkHealthleDist nctn accordance with San Joaquin County I hereby Y ordinances, State laws, and rules and regulations of the q . (Owner and/or Contractor] D. A. Parrish & Sons, Ino. - Estimator_ -''' ------------- -------- (Signed)_ Title -------- - --- -------------------------------------------- -- el i - - -- ----- application)- (Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be filed with this FOR DEPARTMENT USE ONLY -:DATE /t /� DATE ------------ -------- --------- !/ ---------- - --------------------------- APPLICATION ACCEPTED B----------------------------- ---- ------ ---- ----- _----"---_-_"- --- -----"-- --- ---------- ----- -- -- -- --------------------------- REVIEWED BY----------------- ---- - - DATE------------------------------ --------------------------------------------------------------------------- BLfILDING PERMIT ISSUED-----------------•---- ---------- ------------ ----------------- ----- ----- ---- --- Altera#ions and/or recommendations-------------------------------------- ------------------------------------------------------------------------------------------------------------------------- ------------------------------------------- ---- -- ------- --------------- _ `p l -(Date FINAL INSPECTION PERMIT NoBY:-------- -- .-4 -".3---- --• ISSUED_--_-._""-_ -.--I Date----- ----- ----�---------------rr,-- --- - ---------- VV, SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W=1539