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b D APPLICATION_ FOR 4— _R .SANITATION PERMIT Permit No.o� --- •----- '��• (Complete in Duplicate) Date Issued - _v --�-- .��✓ 21 4 App kation 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. 171 -Berkeley- Avenue------------------------------------------ -------------------------------------------- JOS ADDRESS AND LOCATION----------------- _ _ - - - ----------- - H. H. Henning2-1355 -------------- Owner's Name-------------------------------------------------- - --- -------------------------------------------------- Address--------------------- 17 1 Berkeley Avenue - ---e --v -------------- 7------------- D.. A. PARRISH & SONS i ING e ---------------- Phone----------------------------------- ' � p -----------------❑-------- ------=--:---- ❑---------. ------------:- ❑b0 Motel ❑ Other ❑ - Installation will serve: Residence A artment House Commercial Trader Court Mtn $�O Other E] �1 01, Number of living units: 1____ Number of bedrooms ___2-- Number of baths A___ Lot size ----___-----------------------_____________________________ Water Supply: Public system %X- Community system '❑ Private ❑ Depth to Water Table ---40 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe . Hardpan ❑ Previous Application Made: Yes ❑ NoXX New Construction: Yes ❑ No ❑ Replacment TYPE OF INSTALLATION AND SPECIFICATIONS: V (No septic tank or cesspool permitted if public sewer is available within 200 feet.) C C Brick Septic Tank: Distance from nearest wII__None__Distancgnfrom f3 roation7_q_____-_____ t��terial_____________________ ___ QO G81 • ® No. of compartments------ ------------------Size------------------------h -----Liquid 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 trench---------------------------------- ----------------------- -------------------------------. Type of filter material-------------------------Depth of filter material---------------- Total length---------------•------------------------- None ! r Seepage Pit: Distance to nearest well_____________________Distance from to nearest f r _ ---___ e: -------.Depth---------------------------------- Cesspool: ---- ` --------- Pq Number of pits____--------------Lining material_--_ _ --- _ Diameter_--_..__________ Cesspool: Distance from nearest well________________Distance from foundation--------------------Lining material______________________________�______. E Isting Size: Diameter--------------------------------------Depth---•--.:r r=--------L-Liquid yCapacity-----------------------gals. _ Privy: Distance from nearest well-------------------------------------------------Distance from nearest building______________--__._______________:____. ❑ Distance to nearest lot line----------------------------------- --------------------------------------------------------------------------------------- * Existing cesspool to .be abandoned,. Remodeling and/or repairing (describe):----------------------------- ------------------------------------------------------------- ------- -------------------------------------------------------------------------------------------------------------------------------- - - -----------------------•------------------------------------•----------------------------------------------------------------------- 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 +he San Joaquin Local Health District. Si ned A. P�.RRI H SOr35, INC. estimator tor) = � • --- -------------(Title)------------- ----------------------- Contras----- By.. (Plot pian, swing size of Ia+, location of syst in relation to wells, buildings, etc., can be placed on reverse side). ----------------- FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY<?-------------------------------------------------------------------------------------------- DATE_�- ------------------------------------------- 1�7REVIEWED BY----------------------------- ---------------------------------_ DATE--- 1---------------------------------------------- BUILDINGPERMIT ISSUED------------- __ ------------------------------------.------------------------------- DATE-----------�---------------------------.- Alterationsand/or recommendations---- -------------------------------------------------------------------------------------------------------------------------------------------------------- ------•---------------------•-----------------------------•-------- ------------------ -------------------•------------------------------------------------------------------------------------------------------------ /Zoo -- ------------FINAL INSPECTION BY --- --- Date-------------------------------------------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 Sou132 Sycamore Street 814 North "C' Street th American Street 300 West Oak Street Y Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 8-51 'Revised W-2100