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APPLICATION FOR SANITATION PERMIT Permit Nor—A__to__2___ i (Complete in Duplicate) ',/ ry L Q&r e Issued ------ a,2.3'�-- --_ + 1 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descried. 1 This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION.-----42 -Section_Avenuef_._S# IQA Owner's Name----------------------------------- Harrison--A.__Wilson] Phone �"Ssb Address----------------------------------------------------Sage--------------------- ----------- - - Contractor's Name-----------------------------D A, __PARRISH-&-SONS ---INC------------------------------------------ ------ Phone__9-'96D?--------.--------- Installation will serve: Residence t] Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑,Other ❑ Number of living unitsA------ Number of bedrooms ___2__ Number of baths J--- Lot size W__X__193s�________________________--___-___ Water Supply: Public system ❑ Community system ❑ Private a Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel [] Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adoben Hardpan Previous Application Made: Yes ❑ Nom New Construction: Yeses] 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-----3 -____Distance from T�fofundation___g".Material-____qQ__:kqk---- _____Ca acit #I#-,--- No. of compartments----2-------------------Size48"ID X54" de depth-------4$�-__-- Capacity.-8' t each - each I i Disposal Field: Distance from nearest well_-_---50___-_._.Distance from foundation__$____________-Distance to nearest lot line----- _-____ MI Number of lines______----__2-_ _________Length of each line---IQ __&__.r�__Z_-----Width of trench--------50 ___________________ Type of filter material---l�n_--1►-------Depth of filter material----. g-----------Total length--------GO1___•----------------------- Seepage Pit: Distance to nearest well--------_-------------Distance from foundation........------------Distance to nearest lot line_________________. i ❑ Number of pits----------------------Lining material----------------__ ____Size: Diameter------------------------Depth---------- ---------------------- Cesspool: Distance from nearest well-----------------Distance from foundation---------._._--------Lining material_____________________________________ + ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building______-.____._-_-___________________-_-__. ` ❑ Distance to nearest lot line--- -------------------------------------------------------------------------------------------------------------------•-------------------- Remodelingand/or repairing (describe)-------------------------------------------------------;--------•------------•-----------............------------------•-------------••---------------- -------------•------------•-------•-----------------•-----------••-----------•----------------------------------------------------------------------•--•----------------------------------•------....------------------------ 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. i (Signed)Nsing ---_PAR tI54__ a -�v- -C; R = (� Contractor) � ----- ---- (Title) =F.S 'IMATOR (Plot pla size of lot, location�of syste '1n relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY i APPLICATION ACCEPTED BY - --------------- DATE------------- --- ---?..�-- REVIEWEDBY------------------------------------------ ------- - - ----------------------------------------------------------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED-------•------•---------------------------------------- ------------------------------------•-- DATE------------- ' Alterations and/or recommendations---------------------------------------------------------------------------------------------------------------------------•----------------------------------- ----------------------------------------------------------------------------=--------- ------------------------------------------------------------------------------------•-----------------------------------------•-------- ---------------------------------------------------------------------------------------•-----------------------------------------------------------------------------------------------•-------------------------------------- ------------------------------------------------------------------------------------- a h' J FINAL INSPECTION BY------------ -- -------- ------------- Date------•-�.- ---��---- ----�----�---- - ------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California k ES-9-2M 8-51 Revised W-2100