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r�OR OFFICE�CE \ ............__________ APPLICATION FC)R SANITATION PERMIT Permit No. ---- --- ------ ------ ----- --- (Complete in Duplicate) -_---------------- This Permit Expires 1 Year From Date Issued Date issued ----- 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. 'Farridngton Road Rt. 4 Box !i8 Stockton,California. JOB ADDRESS AND LOCATION----------•----------------- -------•-- ---------------------------------------------------------- Owner's Name..........Dr. Peter Kleid. ' Phone_iu•41-2012.............. ------- --•------------------------------------------------------------•-•------------- Address.....................457--Gastro Street San Frncisco,California - ------------••--••••••...............-••--------- Parrish and SonS1106-9607 ------------------------------ - ------------------------------...----------------------------- --........ Phone Contractor's Name-- -• _....••-•-••-- Installation will serve: Residence E] Apartment House Q. Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ l Number of living units:. --- Number1 of bedroomc s _-�--. Number of baths -4-_-- Lot size -� .Acres Water Supply: Public system ❑ Community system ❑ PrivateJ3 Depth to Water Table .50... ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe® Hardpan ❑ Previous Application Made: (If yes,date_195-3---------) No ❑ New Construction: Yes ❑ No ❑ FHANA: 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 well.......... ....Distance from foundation_--_•..-_.__._......Material----------------_--._.__.._._.__......_._.__._.. Exisnng No. of compartments--------- Size---------------------------------Liquid depth-...-.--.. -•----._Capbcity Disposal Field: Distance from nearest,well....5Q-------Distance from foundation._4dt._......_.Distance to nearest I t line1Q0'........ Number of lines------3--:--------.----_----- -_-Length of each line70'.--7a"--_56�---.Width of trench.....241.... ........I........ Type of filter materialg.-.rgq�----------Depth.of filter material--aA--.------,_---Total length----- Q�_•._..•-.-___._•__.---....-. Seepage Pit: Distance.to nearest well-_- .,.---------Distance-from .foundation__9-__._-_•___--Distance.to nearest Iodine----------------- 91 - OOr - ti ] Number of pits----3---------------Lining material._RC1`--.__------Size: Diameter--- �3tr--._..--. Depth---------------_-•------------- Cesspool: Distance from nearest well---------------•_Distance from foundation--------------------Lining material-----------------------............... ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity............................ Priv Distance from nearest well_____________--_- _--- -- ~ "Distance from nearest building Y �- --------- - ------------.................................... ❑ Distance to nearasfi lot line------------------------------------- � I r Remodeling and/or repairing (describe):---------------------------------------------------- ••------ ............ --------............................-..-........................... 3 r I i r 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. Parrish &:Sons (Signed) --------- ----� ..-...- - Owner and/or Contractor By. dill ? ri ht- � /t' ..----....(Title)-----Est. f/� --- --------------------------------- -------------- IF (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed an reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY..---.-- -- - ---- -- - ------------------------------------------------------- DATE---�"----�- --F--- -°'--�------------ REVIEWEDBY-------------------------------------------- -- ----------------------------------------------------------------------------- DATE.---------------------------------------------------------- BUILDINGPERMIT ISSUED---------....... ------------------------------------------------------------- DATE-----.-.---------------------------------------- 5_A..Fter.fSti.o..-n .h.d o-r...r-e..c_-o-m�_e�nda ions•-------------- ---•-•-•---- --•..s --------------------------- ----------------- - ----- - --------------•------- ---- ----- i:------ •• ------•- •--•----•-----------.. - • •-------••--••------------------------- ------------- --------------------------------------------=== ..-.. FINAL INSPECTION BY:.---.....- -.-: _- Date.......,q -- -- --- ----- -L SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8.69 2M 8-61 ATLAS