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APPLICATION FOR SANITATION PERMIT Permit No .2. 9-_ (Complete in Duplicate) C.t!•i Date Issued Application is heresy 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----------- E. Main Street; Stockton - ----------------------------------------------------------------- Owner's Name------µt"�_ ___--- ---_1____----- � WY1iteSCarV@I' ---------------- Phone__�"`675------------------ 1 - -----Whites 733 7• AJ-&e.,U004 E. Main Street . Address------------•-•-------- --------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------_--- Contractor's Name------------------------------------D-. --------------- - - D. A. PARR-ISH &- SONS'----INC+------------------------------ 9!n9_0_7 ContractorsName----------------------••----------•----------------- - -- --- Phone----- ---------•--- i Installation will serve: Residence ❑ Apartment House IN Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ 1 Number of living units: ___3__ Number of bedrooms ---3__ Number of baths 3___ Lot size ___ tR 1 20 1f --------------------------------- Water Supply: Public system E] Community system ❑ Private & Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 99 Hardpan ❑ Previous Applicafion Made: Yes ❑ No [4 New Construction: Yes ❑ No 0 Drain o4ly TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 1 k Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material___________________________________-____________- EXMStin.g No. of compartments------------ 4* Size--------------------------------Liquid depth---------------.----------Capacity--------------t------- (� 1 6 Distance to nearest lot line.___�.......... Disposal Field: Distance from nearest w�l___ 5_ ___.Distgance from found atio �______________ 2 Number of lines-------------- ------------------Length of each line-----------------------------Width of trench____.._4____.__________________ Type of filter material___li°__Rk---Depth of filter material---1an------------Total length---------N_1_________________________ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line________._--.____ ❑ Number of pits---------------- - Lining material----------------------.Size. Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well----------------- from foundation--------------------Lining material____________--____--_--___-_-______- ❑ Size: Diameter--------------------------------------Depth--------------------------------------- Liquid Capacity-------------------------...gals. Privy: Distance from nearest well_______________________________________________Distance from nearest building________________________-____________-... ❑ Distance to nearest lot line----------------------- ----------------------------------------------•------------------------------------•-------------------- Remodeling and/or repairing (describe):__This is only location possible for leach drain and ___--_-__ s..-an•__jmpr9vement_on_-ex stiri�-__condition--------- _----The_ well_ is a _new 11-7_'___casi'rig:::____ --------fob►--- -------------------- -------- -----------••------- --....... -------------------- -------- -------- ---- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify thaf 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. A. PARRI H & S INC. (Signed)----------- -----•- ------------ ----- Contractor) A kBY: - ---•---- -- -----------------------------------------(Title)_D' S3t1IDatOr (Plot plan, sho g size of lot, location of system in rela on to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- ------------------------- ------ --------------- ---------------------------------------- DATE-- � - - -- - REVIEWEDBY---------------------------------------- ---------- ------------------------------------------ DATE--- --------------------------------__ __ BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------ -------------------------------------- Alterations and/or recommendations:_----------------- ---------- -------------------------------------------------------------------------------------------------------------------------------- E ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- i --------------------------------------------------------•---------------------------------- ------------------------------•-_-------•-----------•------------------------------- FINAL INSPECTION BY:--------U+.V- _l --------------------------------- 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 ES-9-2M B-51 Revised W-2100