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APPLICATION FOR SANITATION PERMIT Permit No.F�09?...... (Complete in Duplicate) Date Issued _-�//.��.- Applica+ion 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. QST-- /0& -02 IMICKIE GROVE ARMSTRONG ROAD, WEST OF HI WAY 99 JOB ADDRESS AND LOCATION Owner's Name---Cg�ty_-of....San__Joaqui1; We G. Mickie, donor: W. C. °�geTman, Geri o }• Phone ---9-X18-3----- Address W __.C. Hoe_&erman, Contro. 503 We Elm Ste Lodi. ------ -------------------- -------- -------------------------- -------------•---------------- Contractor's Name ---------------- D. A. PARRISH & SODS, INC* Phone_Ho 6-9607 PuIi Installation will serve: .Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other []Park ` Number of living units: ________ Number of bedrooms _______ Number of baths -------- Lot size __-__MO-x_e._th�__------aGI'CBr� , Water Supply: Public system ❑ Community system ❑ Private sg Depth to Water Table 3 1_ 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 JR No ❑ New Construction: Yes .] No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) - Septic Tank: Distance from nearest w IZ.0Q__________Dista f m+flu ion__15-_-__-_-_--- aterialC---C___._Br ck...----___.______- No. of cam artment........................ _.___�__ _ ____.__. ..Size.*— k ---Li Liquid de th__§0-.___.__._ .Ca aci+ 192D Gals 4 P 00= t$C8 -�------------- q 0 }? P Y .] Disposal Field: Distance.from nearest.welg--. ..__-._..__Distance trom foundation ------------------Distance to nearest lot line________.-- $] , Number of lines2_____._.. Length of each line___ S_.__ each Width of trench-.--.?4 i-_____________________ � 1 rf - 181F---------- Type of filter material_________-.__?-__.__ pth of filter materia!-----------------------Total length-----10___________________________. Seepage Pit: Distance to nearest welL.: Q__._____Distance from foundation--100'..._ taDepth--- to nearest lot line___"__________ Number of pits------- ----------___Lining materia�±C---Hri- Si,,: Diameter_ Ck _____________--_.__._- ----------------- -- Cesspool: Distance from nearest well-----------------Distance from foundation--------------_-----Lining material__.---_.._____- -- ----------- ❑ 4Size: Diameter-------- -•-o--- ---------!Depth-------------------- ---------------------_----Liquid Capacity----------------------------gals. Privy:, Distance from nearest weIL__________________________________----__--._.-_Distance from nearest building------------------------------------------ d ❑ Distance-to nearest lot line-------=-------------------------------------------------------------------------------------------_----------------------------------- s sou Remodeling and/or repairing (describe):_--._.5yg t em___to--be*- lOc aced-at-,rest room on t side of the- Creek,__.across roadway--from the swimming pool easte'rly•__._..-----•• ----•-- ----------------- - f r t i I:here6y certify that I have prepared thisapplication and that +he work ill be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of he San Joaquin Local ealth District. f (Signed)---------PARRISH--&---P,ONS-- -INC- --- ---k :... --------------------------------------( UjxCContractor) __- - / -�- T1tle Estimator t By:-------•-----------•-------------------------------- -------- -- --- --------------( ' ) ; (Plot plan, showing size of lot. location of sys+e i relation to wells, buildin , e+c.; can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- DATE-- �•-----------------1------------------------------- V- BY ................................... --------- DATE -t -------- BUiLDINGPERMIT ISSUED------------------ ---------------------------------------- DATE------- ------------------------- Alterations and/or.recommendations---------------------------------------------------------------------------------------------•--------------•--•-------------------------------------------- - -----------------------------------------•----•---- --------------------- -------------------------------------------•-----------•------------------------------------------•------------------------------------------'------ ------------------•-•-•- -------------------------------------------------------------------- ------------------------------------------------------------------------------- ---------------------------------------------- ---------- ---------------------------- ---------- -- •-------------------------------•-------------•--- - - ------ FINAL INSPECTION B ------- --- -----=` ---------------------------- -- ------ Date---------------- --- --- ----------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Sfreet 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California - t ES-9-2M ; Revised W-2100