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I APPLICATION- FOR-SANITATION PERMIT (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_t---------------AULMf ---2130---Ifebb Avg_.--------------------- Stacktanx Cal. Owner's Name W�R� - BurI1 idG------------------------- --- -A------:------------------- 471141 ,� Phone ------------- A dressa2� -Q` .� ?�'A��_.- - OCQ. a t � ------------------------------" 3 •---------------------------------------=------------------- Contractor's Name--------------D.A.'rParrish & Sans, Inc* eI ------------------------------------------ Phone 78597-------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units::�] Number of bedrooms ;] ,.Number of baths Lot size-_-_--_ 0_ X 1,5q C�3 1 ------------ --------------------------- Water Supply: Public system ❑ Community system ff Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel E] Loam 0 -Sandy ❑ Clay Loam ❑ Clay ❑ Adobe IN Hardpan ❑ .� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) �.la 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--------------------------------------Dept h---•-------------- Priv ' __1 Y Distance from nearest well---- ------------------------------------------_Distance from nearest building ❑ Distance to,nearest lot line________________________________ ---------------- Seepage Pit: Distance.to'nearest well:_ m -!•-----Distance from foundation___50_�-----__.Dii�ance to nearest lot line._ _f____ ® Number of pits'_--_._021-----__ Lining.material__.ggI4_�_---b Sfze.: Diameter.- ------Q+ UP t0 2 - , - -- flepth -�---------- -------------- .Disposal Field: Distance from nearest well-----------•------Distance from`foundation--------------------Distance to nearest lot line,_--____.___.____ ❑ Number of lines_7----------------------------------Length of each line-----------------------------,Width of french--_-___--__-____-____-_-_- Type of filter material--------------- -------------------------Depth of filter material----------------------- ( Addi tianal drai.na Remodeling and/or repairing(describe)------------------------------------------------------------------�,e to eX�.S�,i22�---$�S�ell�] ---------------=- ----- ---- --------------------------------- -----------------„-____.---_---__--__--_!---_--___----______-_-_-____-_-___-_-_-_--_-_-_----_______-__---___---_--__-___-____---__--__-___--------___-___-_------______--_--..____---___--__.____-----_-___..__----_-_---___. I hereby certify that I have prepared this application and tha+ 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. (Signed)---------•------------D,A« Parri sh.& Sons'_' Ince { ----------------- ----------- __----."__Owner and/or Contractor) '" Pr'esideni; By:----------------------------------------- Tale (Plot plans, showing size of lot, loca+ion of system in relation to webs, buildings, etc., must be.flied with this application). FOR DEPARTMENT USE ONLY i APPLICATION ACCEPTED BY--------- c DATE.------ �4�- 7 5- -_. . — /O `--------- IEWED BY ==-- -------- ----------------------------------------------------- DATE-------- -- --------------------------- BUILDING PERMIT ISSUED--------- .- ------------------------------------- DATE------------ Alterations and/or recommendations----------------------- +�- - -- ------- ----- - �.- '"—'� - - -------------------------- - _— - _ _.... . -x-. ------------------------------------------------------------- ------------------------ ---------------------------- PERMIT No-------------------:--__ISSUED--.-----=----- :--------(Da'te) HNA-L''INSPECTION BY:."--� �. — ------------------------------------------------- Dat e--------- ��J t-SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street ES-9-2M 4-50 W-1639 Stockton, California