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. � APPLICATION FOR SANITATION PERMIT y 4 (Complete in Duplicate) i Application is hereby made to the San Joaquin Local Health Dist rict for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No 027 Weber AQe• Stockton 9. ---------------------------------------------- JOB ADDRESS AND LOCATION-----------•----- 3 ---------------------- 1e -• ---------------------- Phoneox1A Owner's Name----------------•------------------•--•---•----- -----•�----- -- ahem Address------------------------- - � -------•---X022--"E..-LCL®bB�--AYe__.-----------------•----------------•----------------------- -------------------------------- ------------------=--------- _ Phone_------�Rg----7------------- D.""A• PARRISH"&""SONSI""_SNC.------------------- Contractor"s Name. ❑ Commercial F1 Trailer Court [1 Motel [j Other E]Installation will serve: Residence 11 Apartment House Number of livingunits: Nu Lot size___. � �� ----- ' I [�: tuber of bedrooms � Number of baths � Wafer Supply: Public system Q Community system ❑ Private F1Adobe H�rdp�,i El Character of soil to a depth of 3-4eet: Sand E] .Gravel ElSandy Loam ❑ Clay Loam ❑ Clay ❑ 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_..I1Koxie....Distance from foundation_.1 �_____,____.Material___.___�___depth--Ck de pth---..5Z!-C_r-__-•Size.__56!W_6riX?3 --Liquid depth----. ------------• y No..-,of compartments=' ----------------CapacitY - Cesspool: Distance from nearest well-----------------.Distance from foundation----_---------------Lining material_._______________- ------------------- . -- ------- -- ❑ Size: Diameter---------------------------------- ep ----•--------------------•-------------- ---- ______________Distance from nearest building----------------------------.------------- Privy: Distance from nearest well------------------------ D . Distance to nearest lot line-----------------------------------------------I Seepage Pit: Distance to nearest well___"_NQm6-------Distance from foundation__, ___.___._:Distance to _ nearest lot line------ Number of. pits---------• ---------Lining matenal__.__•G_,4__XI94a: Diameter----=- --------.Depth.--------2 t----- k Disposal Field: Distance from nearest welL__No1 P-__-.Distance from foundation.____: �-"""___.Distance to nearest lot line_____$t- 0* �� Number of lines, -----------------•---------Length of each line__...---�-•------------- Width of trench__.---?1w-----•----- Type of filter,ma4erial.... l __._�. :.Ff�C-•Depth of filter materia_____ r F V Remodeling and/or repairing (describe) N iY]9 -------------- fi------at30_ --- t ----•------------------------------------------- -----•--------•-------•-------•------_---- t -----------•------•-------------•------------•---------------- 1 --••-----••------•---•-----•------------------------•------ --------- ---• -------- - --- p--- - _. --------I hereb cern# that I have re ared this a- --•----_-----=-------------------------------------------------•------------------------•-----------•---------- pplication 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. Contractor) (Signed) - � :. ------------- -------------•-------------------- ------ •-- -• ------(Title)--- Fto7r'-----------•--------- (plotplans, A I_ '; ize;of lot;location system in relation to wells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY DATE---------- .-------- APPLICATION ACCEPTED BY----------------------------- DATE.-------- REVIEWED BY----------------------•--------•------ --- (-- - BUILDINGPERMIT ISSUED-------------_------------------------------------------------------------------ ----------------- DATE----------------------•------------------------------------- Alterations and/or recommendations____----------------------_-------------------------------------------------------- l ' ----------••-----"---_--------..............------------------------------ ----------- -----------------------------------------------I -------------------- -------------------------- ------------- ---------- ------- -------- -----•- ••. ----------------- K-_--------=----------------------------------------------------- - ` ,f q s / ---- , PERMIT No._. . --------_. ISSUED..."_--•---� .. (Date) FINAL INSPECTION BY:-------=--�-=-=``i-----•---(- } - , - '- ----`------- --- SAN -•-------•- ------_--- ------- ' SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California E5--9.—•2M 9-Sq W-1539