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� 'Ile APPLICATION FOR SANITATION PERMIT Permit No �f_____ __________ (Complete in Duplicate) Date Issued ____ _.2..`f RApplication 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. 2956 Howe Street, Stockton. JOBADDRESS AND LOCATION------------ - ----------------------------------------------------------------------------------------------------------- -------------------------•--------- Louis R,. Brokaw Phone None Owner's Name------------------------------------------- ----------------------------------------------------------------------------------- Address___-.- _ _. 2956 Howe Street - -----w Contractor's Name-----------------------------•------ D. A. PARRISH & SONS ----INC-------------------------- ---- Phone---?79-60 - ----------- Installation will serve: Residence g Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: A-- Number of bedrooms -A--- Number of baths ---__ Lot size _____75_--___x.- 1102 ---------------------------- Water Supply: Public system ❑ Community system fl Private Pq Depth to Water Table 4# ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Ix Hardpan ❑ Previous Application Made: Yes ❑ No)] New Construction: Yes ❑ No ❑ Drainage supplement 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_________________Distance from foundation--------------------Material_________________-----_--____________-________- Exiubing No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity----•---------t------- Disposal Field: Distance from nearest well---70_--------Distance from foundation___ 1 t Distance to nearest lot line----S.-_______ Number of lines------1___------ Length of each line----_-_20_ Width of trench_2-8--------------------------- 8"----------- Type of filter material____ -- -_k__Depth of filter material---lg_____________Total length------------------------------------------ i Seepage Pit: Distance to nearest well----g0t_ .-___,___Distance from foundation-_Z0_i-_____...Distance to nearest lot e---- ------- I ` N Number of pits_______;_____- Lining materialC'C' Brj CCSize: Diameter------- --------Depth------1______________________ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------------------- El _____-_____-___---_______________-_.❑ Size: Diameter--------------------------------------Depth_---------------------------------------------------Liquid Capacity-------- ------------------gals. Privy- Distance from nearest well______----- -: .-_---- --_r------�`�-__Distance from`nearest building==-_'___ _-__:-_______--------- ' 1 ❑ Distance to nearest lot line_---------------------------------------------------------------------- ----------------------------------- ----------••--------------- -- Remodeling and/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. D. . PA, LSiH NSINC : . . + �i �Contrac+orl (Signed}---------- - ----- SO ----------------------( :,w3 (Title _ EStlmator sY� --•------ --..- t,1 = } ------------------- -------------------------------=------ (Plot Plan, sh i g size of lot, location of rstem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- -------------- ----------- ----------------------------------- DATE g` 4 Z— — ' REVIEWED BY-------------------------------- - ----------------------- 9— ---------------------------------------- DATE- --------------------------------------------------------- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE-------------------------- -------------------------------- Alterationsand/or recommendations-----------------------------------------------;------------------------------------------------------------------------------------------------------------..- 1 ------------------------------------------------------------------------------------------------------------ -------------------------------------------------------------------------------------------- ------------------- --------------------------- ------------------------ ---------------------------------------- ' ----------------------------------------------------------------------------------------------------------------------------------------------- - FINAL INSPECTION BY:---------� ---------------------------------- Date-------------- �t�v�� — �----=-------------- SAN JOA UIN 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 ES-9-2M 8-51 Revised W-2100