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APPLICATION FOR SANITATION PERMIT Z22 070-3/ (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---3-r4• house from end of South 'W�dn��,>Av�� West site of St. --------------------------------- Owner's Name-----Payld--- ....-ra•-T ilh-------------------------------------------------------------------------------- ---------- PhoneMante-ca 11 ------------- ----------------- Address----------P'---.0 Bo:� 7_,---Z nteca (Studeba1ter Dealer) Contractor's Name D-- A- PARRISH-& S0-1-Tsz INC- --------• 6--------------------------------------------------- ------------------- Phone------9--96-07--------------------i ----- - Installation will serve: Residence Apartment House [] Commercial I] Trailer Court ❑ Motel ❑ Other ❑ Number of living units: 70 Number of bedrooms;] Number of baths n Lot size--_50__'_X_._1.20-r----------------------------- � fv Water Supply: Public system ❑ Community system ❑ Private ] Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Y] Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan Ej- ,'9 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-_._--_-___--_--_-------------_-------------_-.- ❑ No. of compartments------------------ Capacity---.-------------------Size................................Liquid depth-------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material----------_----___-_---_-------___---. ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------- Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-----_-------------_-_-._--- ._---- ❑ Distance to nearest lot line------------------------------------------------ Seepage Pit: Distance to nearest well-_-------------------Distance from foundation--------------------Distance to nearest lot line----------------- El Number of pits----------------------Lining material-----------------------Size: Diameter-------------- - -----.Depth-----_-_---------------.--------- Disposal Field: Distance from nearest weli-----------------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 prox " ti rht sevrer Line from reale tram Remodeling and/or repairing (describe): -------------------------------------------------------------------------------------------.... -----t°- se' oe f cta=-k��e instal -inn�, 11t4anbke.n.d asoutletto urease traiD and -_. . _ o -. - ----------------- ------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ 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 regulatitris of the San Joaquin Local Health District. PARR SH & SO , I1':"C. ,r i (Signed)------- -'---------------- -------------- --------- ----- - ( ��+ Contractor) By:---- --------- ^' 1 -----------------------------------------------------(Title)-Et�tZ 'idtOz'----------- ----------------------- - (Plot plans, owl si to , ocation of system in relation to wells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.---'--------- } 0n---------------- ---------------------------------------- DATE--------Z/ REVIEWED BY-------------------------------- '"`-----:7 YS ----------- DATE--------------- ---- ---------------------------- BUILDING --- --- --------- ------ BUILDING PERMIT ISSUED--------------------- ---------------•---------------------------------------------------------------- DATE-------------------------------------- - Alterations and/or recommendations:-------------------------------------------------------------------------___--_------------------------------------------------------------------------ -------------------------------------------•------------------------------------------.----------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------- .---------------------------.----------------------------------- ------------------- ----------------------------------------------------------------------------------•---------.------•---------------------------------------------------------.------------------------------------------- -----------------------------------------------------------•• -•------------------------------------------------------------------------------------------------------------------------------------------------------•---- PERMIT No------Z&------- ISSUED------ -- ,--=s �--------------[Date} FINAL INSPECTION BY:------- --------!"_-. - -----_.__-- _-_-.. Date---------------'' � _ SAN JOAQUIN.LOCAL HEALTH DISTRICT 130 South American Street Stockton, California E$-9-2M 9-50 W-1639