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APPLICATION FOR SANITATION PERMIT 3 (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. JOB ADDRESS AND LOCATION------------ 927E. Fremont Street; Stockton - ---------------------------------------------------------------- Owner's Name--------------------------------------------Mr-'---0.-- B.---Lsngford-------------------------------- ------ ---------- Phone�?89-----------------•- ` Address------------------------------------------------------2927---E+__- —reMont. 3t Contractor's Name--------------------------- D--- A-- PA_-RRISH & SONS.- INC. 6 Phone---9.!96©-7------------_ Installation will serve: ResidencOM Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: :L] Number of bedrooms] Numbeof baths X Lot size75!___x121 - -------------------- Water Supply: Public system :K] Community system ❑ Private [X To be discontinued; Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [XX Hardpan ❑ �(\ k TYPE OF INSTALLATION AND SPECIFICATIONS: �@ (No septic tank or cesspool permitted ifpubli ew r is ilable within 200 feet.) o Poe L1a. Septic Tank: Distance from nearest well___2 _�___-__Distance from foundation-__I 21 Septic Mate�riai_C C Bz`�Ck No. of compartments------ ----------------CapacityZOCO---G�_al_Size_M R -u ----- Liquid depth-----3$---------------. -Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------- ! ❑ Size: Diameter--------------------------------------Depth----------------------------------------------- - r Privy: Distance from nearest welf_________________________________________________Distance from nearest building------------------------------------------; ❑ Distance to nearest�,t line______ __________ _ ___ 6 ---------------be.--removed from foundation_________________�35�ante to nearest lot fine__ _ __________ Number of pits----------��______Lining'material...C__C---BriA: Diameter_ __________________.Depth___2_3r___________-__________ 20 I TO be remove$ 2-__ --__--•- �N Disposal Field; Distance from nearest well --- from foundati n_ 2_o_____________Distance to nearest lot line.-_.� ® 11 Number of lines_________ ______ Length of each line____--________________.Width of trench-____�----- 1�4:---R:---- �� --------------------- Type of filter material-----___s_-__-.- k___Depth of filter material1$_________________ Remodeling and/or re airin (describe):______NSW--- - 61.4U-_t1on--- _--- -- ----------------- ------ 31-�_ _�1' I }'�� 0 w --- .1~: 54 .5 .5'' �5 �`� i ' r�L '�P•. �----------------------------`--------------------------------'--------------------------------�---------------------------------------------- T- 7- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. PA : SH ONS-2 . (Signed) - .,- ----- --- ------------------------------------------ 3WX'WContractor] /$y:--------- �� ------- ----- -- ---- ---------------------------------------(Title]_Egtirrmato-r (Plo#plans, sh ng size of lot, location of,system in rel tion to wells, buildings, etc., must be filed with this application). s i R P TMENT USE ONLY APPLICATION ACCEPTED BY----------------------- - DATE --- --- ------------------ REVIEWEDBY------------------------------------------------------------------------------------------------------------------------------ DATE.--------------------------------------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------- Alterations and/or recommendations---------------------------__--_---- ----------------------------------- -------------------------------------------------------------------------------- ----•------------------------------------------------------------------------------------------- ------ --- --------------------- --------------- ----------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ --------------------------------------------- ---------- V-0 ----- ------------------------------------------------------------------------------------------------------------------------------------------- ----- ISSUED PERMIT No._�_�_A -- �---_-_--(Date) FINAL INSPECTION BY:--------------�--_(�.�-----------------------___-- Date=------------------------- { f SAN JOAQUIN LOCAL HEALTH DISTRICT" 130 South American Street Stockton, California I. ES-9-21A 9-50 W-1639 i