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.a APPLICATION FOR SANITATION PERMIT Permit No. .JrO ---- (Comp(Complete lete in Duplicate) Date Issued -------- Applica+ion is hereby_'-ade 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---MICKIE -GROVE. •--.A_•RMSTR©NG-_ROAD_,__WEST__OF__HI-.WAY---99----------------- -------------- Name CQt Ii y �� ._J4J&S u' la... 9 it ink�.e,_dangr; Phone-Fadi -318 Address_W, CO...HQ1P9Pn4an, ("rcnl. Contr.- -5QJ_X•----Elm--- VrAet Lodi*-------------------------------- --------_----- PARRISH__& SONS, INC. HO 6-9607 Contractor's Name------ - -_-.---- -- --------------- --------------------- Phone-----------------------• - Pub-lie Park Installation will serve: .Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ O er Number of living units: -------- Number of bedrooms -------- Number of baths ----__--------------------------------------------- Water Supply: Public system '[:] Community system ❑ PrivateXX Depth to :Water Table -3$_ ft. plus and minus Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes:E No ❑ New Construction: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permit+ed'if public sewer is available within 200'feet.) .�-.---'Distance from foundation_--15_----------.Material__0---�+`--.5rlJa--------------------- Septic Tank: Distance from nearest we1120 No. of compartments---3--------- ---- -----Sizeg6 1D_-X--_7P".Liquid t epth-- -{]l-------------._Capacity-------------- 0 -2-0 gall. Dis osal Field: Distance from nearest we11200;--..._.Distance from foundation_3Q-----_-___-.Distance to nearest to line_- Do Number of lines------2--------------------------Length of each line__Z ,--------------------Width of trench__2941`----_.-----------_------ Type of fi4ter material_dlt'll--_S------Depth of filter material_18................Total length----IS-0-1---------------------------- R QQ - 1" Seepage Pit: Distance to nearest well-___3_Q..-----;Distance from foundation- _..�.___-._..Distance to nearest lot line__ Number of pits----2--------------Lining material---X--Brice: Diameter--4 ------.-----Dept - .-N-1-84-77"t-0.---. -.- Cesspool: Distance from nearest well-- .--:-_�Distance from foundation----------- ------Lining material-----.-_.------.------_--__-___----_. 'Size: Diameter---- - ---- --------------- -- a Depth------'----------------------- --- ---------- ------Li uid Capacity-------- gals. El - - n . Privy: Distance from nearest well ------------------------------------------------Distance from nearest building-- ❑ Distance to nearest'.lot line.----:--------:-------- - ------------------ f . . , 1 S stem is located at the reet__roouge.-.on north___eiae- , Remodeling and/or repairing [describe):-------- �--- ------ ---- ------••---------- -- --- �---•- o ...the__-ox' je�k*_--imimlo-----in__.u-icinity--_of_playgroUnd---Conca$mono, - ---Waat---par-tion- h ------of--- he--park'------------------------ - ---------------------------;------------------------------•------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify fhat I have prepared this application and that the work will r be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of fhR San Joaquin Lol Health District. f, (Signed)---------------PARRISH------SONS-----INC------ a-- - - --------------------- /or Contractor) By:.... :n sire of lot, ' Title Est atOY' ,. - -------- --( � )-...•- • -- ----•---------------------------•----------- (Plot plan, showing of system in re afion to wells, 6uildin,. etc., can be placed on reverse side). FOR DEPARTMENT USE NLY k APPLICATION ACCEPTED BY--- ---- --- --------------- ----------------- DATE-_1: ------------------------- REVIEWED BY-------------=-------------------- DATE ` BUILDINGPERMIT ISSUED------------------ -------------------------------------------•---- ----•---------------------------- DATE--------- ------------------------------------------ Alterationsand/or recommendations------------------- -------------•-----------------------------------------•----•-•------------••--------------------•----=-- •-•----------------------------- ------------------------ -----•------------------•- --------- -------------------------------------------------•-------------------•--•-----------------••-------------------- 1 ---------------------------------------•-----------------------•-----------------------•--•----------- --------- , ------------ --'-------------------------I--------I--------------- -------•------------------------•------- = ---•--- 1 FINAL INSPECTION B .---- -= - = -------- ------ = -•---- ate _ SAM 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 FS-9-2M ; Revised W-2100