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APPLICATION FOR SANITATION PERMIT 3 (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--------------- -- -- -------------------- Owner's Name--------------------•---- ----------------------Wi._- 1 M...Valentine---------- ------------------ Phone--------------------------- ----------------------- Address- 43�+'---B.-JkshtnztonStree_ t - - - ------ Contractor's Name------------------------------------------ e___— .___Parrish_ & ions Inc-.--------------------------- Phone-------•--9--- �--9 07.___ Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: f0. Number of bedrooms 70 Number of baths [31 Lot size-------5QI_XI..001-------_____-------------------- Water Supply: Public system ❑ Community system ❑ Private [A Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[$ Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) W Septic Tank: Distance from nearest well____5.O_t------Distance from foundation------- 1-0_l- M11exCC Brick No. of compartments--?--------------------Capacity-----------$QD---Size----- Mid depth- - r� 2 Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- ElSize: Diameter----•---------------------------------Depth---------------------------------------------------- Privy: ---------------------------- ------------------Privy: Distance from nearest well-------------------------------------------------Distance from nearest building ---------------- El t Distance to nearest lot line_________ - ------------------------ Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------.Distance to nearest lot line------------- -_ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter------------------------Dept h-----------------__ -------------- Disposal Field. Distance from nearest well-------601---Distance from foundation____--j Q1-_._.Distance to nearest lot line---5!---__----- Mx Number of lines-_1----------------------------Length of each line-----------60_ip 2 of trench------__54----------------__-- Type of filter material_____��!1___R __Depth of filter material_____-_�,$s�_____--- Remodeling and/or repairing (describe):----------------XeW--j$'S_ta11 i_on_____-----------_------- ----------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, tafe la s, and rules Andregulations of he San Joaquin Local Health District. (Signed)---------BS &- - NQS ----------------------- ------------- ------'-----------------------'----------(O�Contractor) By--------------------- -- ---- --- -------- --*-------- (Title)-- ' _t1FlIzS t4x' (Plot pla , showing ze of lot, on of syst m in relatio to wells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------- DATE____---_--__ :-__ REVIEWEDBY----- ------------------------------------------- - -------------------- -- -- ------------ --------------- ------- - DATE------------------------------------------------------------ BUILDING PERMIT ISSUED ------------------------------------------------------------------------------------ DATE_ Alterations and/or recommendations-------------------------------------- ----------------------------------------•--------------------------------------•-------.-------------------------------------- ---------------------------------------------------------------- ---------------------------------------------------- i -------------------------------------------- V - -- - ------------------ -------------------- -------------------------------------- PERMIT No.__-- --_----- ISSUED -- ��---------(Date) FINAL INSPECTION BY:---- -v_ ---- Date------------ = SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street E$-9-2M 9-50 W-1639 Stockton, California