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APPLICATION FOR^ SANITATION PERMIT (Complefe in Duplicate) } Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. y rNo. 549. D77^- 7530 ,-3 �l This application is made in compliance witho { Or�ine ce ` � of Mes.dosv & Caran A;Ve* Pp _ - ry - ,�� 4oul ,4✓� febster,) N.Wr_ Cor. JOB ADDRESS AND LOCATION--------------------- ; -------------------------- - ------------- Warren Webster --- Phone--------------------- ------------- Owner's Name------------------------------ - --------------------- ----------------- - --- Address - ------------------ 13o7 Meadow Ave ` Address------------------------------------------------------------------------------------------------------------------------------------------------ •----------------------- -------------------------------------- Parrish ---------- ---------------------- B.A, Parrish & 5ons,___Ina. 87-8597 Contractor's Name----- Phone Installation will serve: Residence IN Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:Z] Number of bedrooms , �� j 1251 Number of baths Lot size-------•-------------•----------- Water Supply: Public system ❑ Community system ❑ Private �1C1 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.) r g t .. . Gon»�-Blks. .. .�.t Septic Tank: Distance from nearest well______;50___:-Distance fr,p m�fou dation__ - _ _________- tenal___.-_______________-_---_ .x ri[29No. of compartments---•- t1d0- --V--Capacity--70C--- •--- Size 3-----------Afuid depth------fir------- --------Cesspool: Distance from nearest well____-_________ Distance from foundation____________________Lining material____---- ___-_________------____❑ : vSize:`Diameter-----------------------------------� Depth---------------------------------------------------- ' _______Distance from nearest buildinPrivy: •-'Distance from nearest well - ------------------------ g - Distance to nearest lot line___________' --------------------------------- t _Seepage Pit: Distance to nearest well_____92`___2t�-Distance from foundation___2a'___-___ �Vnce to nearest of Jine______ -______Number of pits----arl ._---_-- Linin mater.ial.C'On"_ Br.Size:,Diameter------------------------Depth------ --------------------p well 50 ' 20 ' ------------ Disposal t - ____.Distance from foundation-_ to near�st`�ot Gne.-�___.________ Dis so�sal Field: Distance from nearest OriF, N� Len th of each Ime_____7 _ Width of {rench___��__YY______________________________ ANumber of lines-- -------.--- ,_-ii -- g r lett---------- Type of filter material`_-?_____3'p,c4Depth of filter material ____________________ Netr .SystenR Remodeling and/or repairing (describe)------------------------- ------------------------------•- ------------------------------------- ---'------------- ------------------- ..- s '� --------------------------- % ----------------------------=,------------------------_---- 1 - l \- � --------- - ------------------ ------------------------------- , --------------------------- - �..,:v1 k ------------------------ -------------- ,,. v„ - ... I hereby certify thatJ have prepared this application and that-the work`will`be done in accordance with San Joaquin County ordinances, State laws, and rules. end-'regulations of the San-Joaquin Local Health District. (Signed}== , / --�= -""'-C -- ---- r-'�!�' ----------------- and/or Contractor) -- __(O era tor) (Title] P 'C Ses�------------------- ------- By:--•------ ' ---- --------- -- 1 (Plot plans, showing size of lot, location.of system in rela ion to wells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED.BY_- _ g %-----------=-------------- DATE__-__—,_-f.--+—--- ----- ---------------- �'r ` f�`�- ----'�-------------'�.�" REVIEWED BY' " = "= _" _----- -' � -_ = ------ ------------- - DATE-- BUILDING PERMIT ISSUED----------------------------- s --•------- DATE----==----------_Y--------- f Alterations and/or recommendations-------------------------------------- -------------- ----------------------------------------------------------------------------------------------------- ------------ - --------------------------------------------------------------------- --------------------------------------- ------------------------------------•-------- -------------------------------------•=---------------------- ----- ------------------------------------------- ------------•----------- ------------- -------------------------------------------------------------- ------------------------- � 2 -------- ISSUED-----_ = - 4 ate FINAL INSPECTION BY: - PERM 1T No-----�`�- --- _ - - � � iDate.--------- `�'Q--------------------------------------•----- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American-Street Stockton, California t EES-9-2M4-50 W-1634 F 3 �