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APPLICATION FOR SANITATION PERMIT Permit No. ______---------�___-- (Complete in Duplicate) Date Issued ------ g ----1D 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. i a i JOB ADDRESS AND LOCATION..____._._503$_E..___Washington St. .Stockton -- -- ---- - ---- --- - - -------------------------------------------------- Pentecostal Holiness Church Owner's Name- -------------•-------------------------------------------------------------- Phone----HO- 03-------- Rev. Hale, 67 No. Walker Lane Stockton. Address. --- ----------------------------------'--------- - ---------- Contractor's Name------••---------------------D D. A. PARRISH & SONS, INC . HO 69607 •------------------------------ Phone----------- ------• 9 . Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other IX Church Number of living units: -------- Number of bedrooms -------- Number of baths ___ `__ Lot size _____ - �_t._ ____._10-Q-_-Brox,._---_ Water Supply: Public system [X Community system ❑ Private ❑ Depth to Water Table _a?.a_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam E] Clay Loam E] Clay ❑ Adobe� Hardpan E]Previous Application Made: Yes ❑I No (& New Construction: Yes ❑ No ❑ Replacing existing System. . TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) t None 10 CC Brick Septic Tank: Distance from nearest well__-__--__-_._.._Distance from oundation----- __...____. aerial_______________ _-.___-______. Liquid depth_._-....___ 1000 Gals ] No. of compartments 2--------- Size.__ �"?1§0....e ep . z Capacity ' Disposal Field: Distance from nearest well.PAP.__Distance from foundation-----IQ-1-------Distance to nearest lot line---5-1________ " 1 Number of lines____________________ _ Length of each line----__3o-t__---_---------Width of trench_ 2_t��______---___.___.__._ Type of filter material._..._?�t- _Rk-Depth of filter material--- --------Total length-------- --- �----------------------------- Seepage Pit: Distance to nearest well..-N(?Aq-------Distance from foundation____10_t..___..Distance to nearest lot line_.____51-_--- Number of pits.-I---1-------------Lining material_Brick------Size: Diameter-------33 --------Depth-__----2 f-- --------------- Cesspool: Distance from nearest well-----------------Distance from foundation---._..-------------Lining material Size: Diameter.- --------------- ----Depth------------------------------------------- -----Liquid Capacity-----"'-1----------------- gals. Privy: Distance from nearest v;ell--------------------------------. ---- --'"Distance from nearest building------------------------:_____----___.._. ❑ Distance to nearest lot line--------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):____ '.-.For-_Church__bu ldjAgx_s,_.---2._.toilets-,--wash bas . j Kitchen--s in k a -------------------------------------------------------------- . -------------------------------------------•--- --------------------------------------------------------------------------------------------------------•---------- --------------------------------------------------------------------------------------------.- 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 aquin Loca ealth District. A. A, PARRTSH._.& `SONS,--.-INC ._ _� -_ {C 'c3 Contractor) (Signed) - - --- --- -- --- -------------------- - Sy:------------------------------------------------------ ------------- -----(Title)------Estimator------- ----------------------- (Plot plan, showing size of.lot, location of system in relatiof to wells, buildings, tc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- --------------------- ---- -- ------------------------------------------- DATE------- - REVIEWEDBY----- ------------------- ----- ------ --- --- --- ----------------- ---------------------------- ------ DATE------- -- BUILDING PERMIT ISSUED----------------- ............. - ------------------------------ ---------------------------------- DATE..------------- Alterations and/or recommendations:------------------------ --- -------------------------------••---------------•---•------------.-----•----------------•-----.--------- ---•---•-•------------------------- ------------------------------------- ---------------- ---------------------------- -----------------------------------------•-------------------•------- -------•-----------. ----- -------------------- ---------------------------------------1------------------------------------------------------------------------- -----------------------------------------------------------•---------,----- ------•--- -----•---------------------------------------------------------i ----------------------------------------------- --------- ---------------------- -----------••-------------------•-------- ------------•--------_ -------- ------- . ----------••-------------------------------•-------------------•-------------------------------------------•----------- FINAL INSPECTION BY:------- -- . -- 5---------------------------- Date------tom.. �f Sf -------------- ---------------------------- , SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street I 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES145446 ATW tlOO ,2-54 711, _ `