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_ 3 APPLICATION FOR SANITATION PERMIT Permit No. - ... .......... (Complete-in Duplicate) 1 O ~3 } Date Issued ......... Application is h eby 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. 3710 140, California St. Stocktol-I (Studio Apt, in rear) JOB ADDRESS AND LOCATION - ------ - DonaldC. P].��tt Owner's Name---------------•-------------•-• -_----- ----------------------------------------------------------- --------------------- -------------- Phone-------------------•-•------------- Address------------ -- -- Same PAR.RISH INC. Phone_...9_-------------------------- Installation �----_.7 � Contractor's Name-----------------••------- -•--------------------------------------------------------------------------------------------•- ----- •----.. Installation will serve: Residence ❑ Apartment A&VEJC*Commercial ❑ Trailer Court Motel ❑ Other ❑ 65 Number of living units: __1___ Number of bedrooms __�'___ Number of baths 3------ Lot size �X___124-1but �O -l-able cava �4x 20- �va-i , Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe NC Hardpan ❑ Previous Application Made: Yes ❑ No J�K, New Construction: Yes ❑ No ❑Yes a • • for studio apt. A TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) CC Brick Septic Tank: Distance from nearest II_Npn------Distan e fffople`iap undation__8______________M trial_;.___..____._______..___ vv,,�� No. of compartments__--1-------------------Size--- ��_---- -----Liquid,depth_____5-----------------.-Capacity ]__ ffin Disposal Field: Distance from nearrf well_---NOrie Distance from foundlorr�?R�._-_ai&Distance to nearest lo It e o .� Number o-i lines-------------- _ ___ ___Length of each line------- _ �______._-Widfh of trench.___ ___ _ p_e . ho Type of filter mate Depth of filter material_____8___..__--_._Total length_____3'"_ ______ _._____� Seepage Pit: Distance to neare f well...hT��E-----___Distan eCfr�m oupdation__-:_� __....___-3�jPnce to nearest I life }'4 Number of pits ---------------Lining materia---- --- K ------------------------,jJDeptn G r C Size: Diameter -------- Cesspool: Distance from nearest well-___________..__Distance from foundation-------------------_Lining material__--__------___.____._________-_____. ❑. �- Sita: Diameter ---------------------------------Depth_ Liquid Capacity = gals, Privy: Distance from nearest well - _ .__.___ _ -----------------------------Distance from nearest building ------_---_-.______________ _-_._. ❑ Distance.to nearest lot line------------------------------------------------------------------------------------------------------------------------------------------ -- *To serve studio apartment. . . limited space availa Remodelingand/or repairing (describe):--- ---- ------------------------- ---------------------------------------------------------- •-------------------------------------------------------- -----•--------------------------------•-------------------------•----------------------------------------------------•--••----------------------------------•---------------------------•---•-------------------------- ----- -------------------------------- -------------------------•--•-----------------------------------------------------------------------------•-------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the wor will be done in accordance with San Joaquin County ordinances, State laws, and rules and r ions of the San Joaquin Lo Health District. PRRISH INC { Cantractorj(Signed)--------------- -------•--------------------- -•---------- Estimator By---------------_-- --------- ------------. ------- � ---------(Title)---------------------------•----------------------------------- (Plot plan, showing size of of, location of sy m ti-relation o wells uildinn �s, etc., can be placed on reverse side). FPR DEPARTME "T USE ONLY APPLICATION ACCEPTED BY_ - ------------------- DATE --------------------------------------------------- REVIEWEDBY-------------------------------- -- -------------------------------------------------;-----------•--•-------------------- DATE..- _ - BUILDINGPERMIT ISSUED-----------------------------------------------------------------------------------------------------. DATE---------�--------------------------------------------- -- Alterationsand/or recommendations------------------------------ -----------------------------•---------------•----------------------------------------------------------------------------------- ----------------------------------------------•----------------- ---------------------- --------------- -- •---------------------------------•--•-------- -----------------------...--------- ------•------------------- R ------------------------------------------- _------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------- FINAL INSPECTION BY%:----=- ------ -------------------------- Date......... � r -------- -------------^ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 8E4 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M J0-52 Revised W-2100