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APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) `3 .,, Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described 'J This application is made in compliance with County Ordinance No. 544: t .^` 1 JOB ADDRESS AND LOCATION.............. z ...q!?urit Cl U,0 l�lvc,. Owner's Name.............. _....... ....._..............__. ............ .?. tan "Ifi.ed SClinol Dietr. `.... n, Cal. 4 .................................... „- Address....__...... ?� Spn Josnu'ltz .itree n . ........... ........ „ Phone a Contractor's Name..............D.A. Parrish a ..._...'................ ..................................................:...........::'....._............._._..:......... 1 Soils,• ti>3 Trac. .. j Ph _ 597 Installation will serve: Residence IN Apartment House ❑ Commercial Motel ❑❑ Trailer Court .'' ❑ Other ❑ Number of living units: ] Number of bedrooms Water Supply: Public system � � Number of baths Lot size:..��C.-;;•_�••_3�?�1,........._,•._...� t a y ] Community system ❑ Private ❑ .•..... 4 - Character of soil to a depth of 3 feet; Sand❑ Gravel C Sy Sandy Loam❑ Clay Loam© Clay +� ❑ pan H ❑V. i TYPE OF INSTALLATION AND SPECIFICATIONS: Adobe ard ! . (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 4. x Septic Tank: Distance from nearest well.................Distance from foundation.. ;- ❑ No. of compartments...._ ...Capacity ..Size..................Mater...Liquid depth V Cesspool: Distan •�••••--••-•• _ _ Distance from nearest well... _ ...Distance from foundation_........ i •r Sae: Diameter..._... ........... Ening material............. �- Depth ................. L' privy. _ ........... ' € vY• Distance from nearest Well. Distance to nearest lo ... ..Distance from n i r. ❑ .........::.. Barest building ...._..Distance to n line... ............ { Seepage Pit: •• ....._.. :�+ - Distance to nearest well......................Distance from foundation._.____.._ ❑ Number of pits......................Linin m Barest lot line....._. ._._..- Number of lines...:_.OnC I1on C 5 s Distance -Depth................................. p g materia)....................... f ,. { Disposal Field: Distance from nearest well................ Distance from found Size: Diameter............... a RO Ck•Length of each line.alb �- - Width of.,,french.nearest Eine._ 8 s t t Type of filter materiaiI g - Wi trench.:.......... ................� I a:_........ ..Depth x2 i ......•- of filter materia[..... .. ..... Remodeling and/or (describe):repairing ....................:'$�citio... .-......._.- . 'fI{ti ..................„............._........._..._.--•-_-_.-••_-_........_.„...._._........_............._.-...._.........,..._._.._.._....•��._...._.._....-_....._._... .-.•... ........... •.A *1 ... 1 S ....................................................................... ...... ............_......_._....__....._.......__..........._......__.....-......_...__�i - •.................... hereby certify that I have prepared this application and that the work will be dons in accordance with San J uin S i. , N i ordinances, tate laws, and rules and regulations of the San Joaquin Local Health Di:fric}. oaq �� (Signed)...................D•A. Par I 2c Dons ......_-... .................. r= , ?I t _... --� and/or Contraefor (Plot la .�....... President plant.showing size of lot, location of s ifle ............. ) ystem In lotion to welh, but Ings, etc., must be died with this appl'icatio -.-------- ; rj t ---- FOR DEPARTMENT USE ONLY .} APPLICATION ACCEPTED BY............... x REVIEWED BY BUILDING rERP. '-...__...._.. �lT ISSUED._.. .............................. ........... ...._ - DATE.... DATE. e',,,/ • �-- - � J.... +h. A,reratians and/or recomm •' DATE.. / endatrons:.................... ................. F ............... ..................................................... .: ----- .......................................................... ............. ...................................... .............. _-----. ISSUED._.!.(:_:.-.'.'4.......� ..........(Date) FINAL INSPECTION BY:_..__.._..__ ............... ................................... Date.............. r _ , SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 4L ,IL39 Stockton, California I