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APPLICATION FOR SANITATION PERMIT Permit No4.4-- (Complete in Duplicate) Date Issue 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. 2536 E. Myrtle St . . . Stockton JOB ADDRESS AND LOCATION •------ ----- •- ----- -- -- ------ -- ----- ---- -- Mrs. T®>>r>�ie 9as�er HO 2�-7718 Owner's Name------------------------------------------------------------------------------------------------------------ ----- --------------------------------- Phone------------- •--------------- Same Address--------------------------------------_---------- -----------------•---..-..------------------------------------------------------------------------------------------------------------------------------ Contractor's Name---------------------------------PARRTN C • HO 6.-96Q7 -- -R Phone --o 6 Installation will serve: Residence& Apartment House ❑ Commercial ❑ Trailer Court �] ! Motel I Other E]Number of living units: I_____ Number of bedrooms ---2.- Number of baths _1'____ Lot siz ------ --- ------------------------------------- Water Supply: Public system 4* Community system ❑ Private ❑ Depth to Water Table�!--- f+, Characterof soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe A Hardpan ❑ Previous Application Made: Yes ❑ No A New Construction: Yes#] No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) None ' CC Brick Septic Tank: Distance from nearest wel ______ ___Distaf �e fo d _____.___ -- toprial____---__-----_-____--_ _- `� x�� - 800--Osis. ME No. of compartments------ -------------------Size-�------- -------- squid depth----------------- --------Capacity...---------------- -- ) Disposal Field: Distance from nearest well-----------------Distance from foundation-_--_______________Distance to nearest lot line____________----. ❑ Number of lines-----------------------------------Length of each line------------------------------Width of french.---------------------------------- W Type of filter material--__--_--- ----_Depth of filter material______________________Total length______________-_______________.___________ f t Seepage Pit: Distance to nearest ell_N©��-________Distanr�dfiomifoyclation___--8-__-_--�[�i�tance to nearesf8line_________________ Number of pits-------- ------------Lining material----------- --------Size: Diameter------------------------Depth------------------------ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material__.__.-_----_______._______.__.______- ' ❑ Size: Diameter----- ----------- ---------- ------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building____________------------------------------ ❑ Distance to nearest lot line---------------------------------------------------------------------------------------------- ----------------------------------- LIMITED SPACE.. . Remodeling and/or repairing (describe):-------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------..-------•------- -------- ------------------•-•-•----- ------ (O -----------------------------------------------•-•---—. -------------- -.-----------------------------------------------------------------.-------------.--.-----------------------------------•---------------------------. --------------------------------------------------------------------------•---•------------------------------------------------------------------------------------------------------•--------------------------------------- I hereby certify that 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 Joaqui 'Local Health District. PARRISH INC. . * �+ (Signed)---------------------------------------------------------- -:---- ------ ------------ ---------------------------------------------------------------(&� � Contractor) Estimator By:_-----------------------. _- - - ------ -----�� [Ti#le) - ----- - --------------- --- - - -- (Plot plan, showing size of lot, to tion of sy a in relation to wel uildings, etc., can be placed on reverse side). FOR DEPARTNIT USE ONLY APPLICATION ACCEPTED BY------------------------------------------------------------- V_) -7------------------------ DATE---------------7 ------------------- REVIEWEDBY------------------------------------------------- --------------------------------------------------------------------------- DATE----------------------------------- --- BUILDING PERMIT ISSUED------------------------------- --- ------------------------------------------------------------------ DATE------------------------------------------- -- - Alterations and/or recommendations:------------------------- ------------------------------------------------------------------------------------------------------------ ----------------------- ---------------------•------•----------------------------------------- ------------------------------------- ---------------------------------------------------------------------------------------------------------------- ---•-•-•--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------- --------------------------------------------/--- --------------------------------------------------------- -------------=--------------------------------------------------------------------- �FINAL INSPECTION BY:----------------- ----� . -----•-- -- Date---- -- - ----- -_ -- -J ----------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stock+on, California Lodi, California Manteca, California Tracy, California ES--9-2M ' Revised W-2100