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APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Application 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. 15 JOB ADDRESS-AND"LOCATION----RTt I-- 237 Lodi ---Ai--Way--99--north of_8_�.l.e_read---------------------------------- -} +� Owner's Name----QM__P61t--- er__Courtg_"_{331q@ '&_-W ,]. t_&_Xt$s1__Wdlf---------------------- Phone-IM d3__Q2553--------- Z Address Wit• �r Bog-"23 -.9-----LOW -�------------------ p Contractor's Name------------------D -. -_PARRTSH__& -SONS. INC. ---- Phone-----%-9b4`l Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court [I, Motel ❑ Other ❑ Number of living units: ❑ Number of bedrooms ❑ Number of baths ❑ Lot size--- cQUTt**---------------------- Water Supply: Public system ❑ Community system ❑ Private 21 Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Ej Hardpan ❑� TYPE OF INSTALLATION AND SPECIFICATIONS: f-4 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ~� Septic Tank: Distance from nearest well------_----------Distance from foundation--------------------Material------- --------------------------_-.. W in No.:of compartments----------------- ----Capacity-----------------------Size------------_-------------------Liquid depth-------------------------- .-Cesspool: Distance from nearest well-_--------------Distance from foundation------------------- Lining material------___-_-.---___------.. ❑ Sizd: Diameter--------------------------------------Depth----------------------- -Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ El ---------------.------___----_--------- -❑ Distance to nearest lot line------------------------------------------------ Seepage Pit: Distance to nearest well_-_------------------Distance from foundation-------------------Distance to nearest lot line---------------- 17-1 Number of pits----------------------Lining material-----------------------Size: Diameter------------------------Depth_--_--------____-----___--- •._Disposal Field: Distance from nearest well------------------Distance from foundation---_-_" Distance to nearest lot line----_------------ ❑ Number of lines-----------------------------------Length of each line------------------------------Width of trench-------------------------_" Type of filter material----- Depth of filter material------------------- 'Remodeling and/or repairing (describe):----_-- 5{� �---on- o--- -4h'_SBWer line._$----- __ TBCe ving_St,�t7pAs,__------ -------for_--trmller-_eta"1 ne�l,_-2--_clean-_fl�t$��------This:-1im--will_-i�andle---__ taste--tram---8---trailers------- -------s.nd--X ll--fit"-into---existing---septic-_tank---------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ 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 Joaquin Local Health District. (Signed) A:._-PARRTSH &_ SONS' INC. • '- ft:---------------- Contractor BY: - -----------(Title)-----Est1 i8to ------------------------------------ . (Plot pla , s wing size of lot, location of st n in relation to wells, buildings, etc., must be flied with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY____ _--" DATE__-1/�------------------------_-------__----------- REVIEWED BY �----- --------------- ---- DATE / � ------- - _ BUILDING PERMIT ISSUED--------------------'-'---------------------------------------------------------------------------------- DATE------- `lS`! Alterations and/or recommendations------------------------------------------ --------------------------------------------------------------------------- ---------------------------------------=------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------- --- - � ---------=-------------------------------------------- E - e PERMIT No.__ -` " - ""--- ISSUED----_(_t_" -----------(Date) FINAL INSPECTION BY:-----------Z/7_,;F ---- - ----- Date------------------------------------------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street. Stockton, California ES-9-2M 9-50 W-1639