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APPLICATION FOR SANITATION PERMIT Permit (Complete in Duplicate) Dale 1 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. JOB ADDRESS AND LOCATION....---- S03- Farmngton _Rod- ------- tockton---------------------------------------------------------------- Owner's Name William �._-TuCker----------------------------------------------------------- Phone- 6'-'6-�r00--------- Address------------------------------------------------------�8Q8 Farmington_Road-3----- StOCkton.----------------------- D. A. PARRIaH & SONS , INC.Name-------------------------------- --- _---- ---- --_----------------- .Phone------9960 7 Installation will serve: Residence [N Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _1____ Number of bedrooms ___ _ Number of baths _ ----- Lot size _:----I_Acr4,_n-s____________________________ Water Supply: .Public system ❑ Community system ❑ PrivateNN Depth to Water Table -AP It. (30 Character of soil to a depth of.3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ® Hardpan ❑ Previous Application Made: Yes ❑ No,'q New Construction: Yes PC No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: Q (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_-70_r______Distarice from fo ndation_-6_�___________.Material----C _C; BTiCk- --- ----------- �] No. of compartments_______ __________ Siza -_n ��_x---3"__Liquid depth--_---52n-------- --Capacity-__ �OD G��. Disposal Field: Distance from nearest well---$O.T------Distance from foundation-__1-6----------- to nearest lot line---------- 3__ �f Number of lines--- 1_________ _________________Length of each line----2P 1-----------------Width of trench----2�'------------------------ Type of filter material_3.2�___Rk___.-_Depth of filter material-'15-8n________.__Total length--------2O_¢------------------------- Seepage-Pit:. _ ._ .Distance to nearest well___100_T______Distance from foundation---l�_...........Distance to nearest lot line_ld_=__---_- 6. - 1 CC--- Diameter-- -- -.---------------Depth______.__ _ ______________-- Cesspool: . Distance from nearest well--- _-- ----_Distance from foundation--------------------Lining material-----------------------_-------------- Size- `Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity--------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building__-_________-__:___________________ e ❑ Distance to nearest lot line------------------------=---------------------------------------------------•----• '------------------------------------------------------- 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 the San Joaquin Local Health District. (SSi ned A. PARR S-H &--SO-NS, INC, ( Contractor) igned) --- ----- ---------------- --- --- ------ ----- - INC-- By:---------------------------------------------------------------------------------------------------------------------------------(Title)- By:------------------------------------•-----------------------------------------------------------------------------------------------(Title)- Estimat©r ---------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- ------ ----------- - - -- ------------------------------------------------------------ DATE- -- REVIEWEDBY. --------------=------------------------- DATE------7�` ----------------------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE----------- Alterations and/or recommendations------------------------------------------------------------------------------------------------•-•------------------------- -----------------------------------------------------------------•--------- ---------------------------------------- --------------------------------•--------------------- - ---------------------------------------------------------------------- ------------------- ---------------------------------------------------------------=--------------------------------------------------------------- -------------------------------------------•------ -----------------------------------------------------------------------=-------------------------------------------------------------------------------------------- --------------------------------------------------------•- ------- FINAL INSPECTION BY:------;101� w ----------- Date---------------- ------ - ----- --- '---------•--- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 Norfk "C" Sfreet Stockton, California Lodi, California Manteca, California Tracy, California E5-9-2M 8-51 Revised W-2100