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APPLICATION FOR SANITATION PERMIT (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__1826 Sherman Avenue - - - - - ------------------------------------------------------------------------------------------------- Owner's Name-----------------------------------f Constant J. Cam-pbe� I----------------------------------------------- Phone----271597 - - - Address------------------------------------------------ ------------------------ -----------} 826 Sherman Avenue Contractor's Name---------------------------I D- `-. PA SH & SONS, INC' Phone-----9r260 Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number-of living units: [2 Number of bedrooms] Number of baths Lotsi.e8Vx_._110 t Wafer Supply: Public system EX Community system ❑ Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe IX Hardpan ❑ 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_-N�_f_-Distance from foundation`-�a ____.___.Materi x Ex{_cTng No. of compartments----------------.........Capacity----------=------------Size----------------- Liquid depth-------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material__________-______________---_________ ❑ Size: Diameter--------------------------------------Depth--------•------------------------------------------- r Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_____________--_--_____________-______ ❑ Distance to nearest lot line____________________ � 1 C r Bra io 1S'------Dlisstrce to nearest t -Seepage Pit: Distance to nearest well_N4Zl-P---------Distance from foundation_________ J est lot li�e____1 _______ ` Number of pits----------------------Lining material----_-_--___---------- Diameter------_..__-----_-_ Depth __ 777� Dis osal Field: Distance from nearest well __ __ _Distance from"foundation_____________--____.Distance to nearest lot line_'__="_`_"-".'"" ❑ Number of lines----------------------------------Length of each line------------------------------Width of french----------------------------------- Type of filter material-------------------------Depth of filter material_______________________ Remodeling and/or repairing, (describe):----------ftp p1eg8q; 'r---to---existing drainage system. . • ------------------------------•------------------- ------------------------------------------------------ -----------------------------•--------------------------------------- --------------------------------------------------------------------------------------------------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 (Si ned A. PARR H SON-, II -C--*- - . ' 9 ) -' v L --- - - -------------------------------------------------------------------------------(� Contractor) i, sy:-------------------------------- ? A,.�-i - - ------- Title Estim for Contractor)-,,,, ------------------------- I ----------- (Plot plans, shoing size of lot, location of system in relation to wells, buildings, efc., must be filed with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED Y__ - ---------- --------------------------------------- -------------------------- DATE _ _ --rt'2 REVIEWED BY-------------- - --- ---- ---: DATEr BUILDING PERMIT ISSUED----------------------------- --------------------------------------------------------- ------------ DATE ---------------------------- Alterations and/or recornmendafions ------------------------------------------------------------------------------------------------------ --------------------------•--------------------------•-------I-- ----------------- ----------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------•---------------------------------------------------------------------------------•----------------•-----------------•-----------� ��--------•- ------------------------------------------------------------------------------------------------------------------------------------------=--------------------------------------------------------------------------- ----------------------------------------------------------- ------------------------------------------.....-------------------------------------------------------- ---= PERMIT No-----b_ 4--------- ISSUED___�_� _"S-�----------------(Date) FINAL INSPECTION BY:________-___ -- -----------,_Z -i---------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street n- Stockton, California ES-9-2M 9-50 W-1639