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APPLICATION FOR SANITATION PERMIT Permit No. .O'---=" P----- (Complete in Duplicate) Date Issued __- u/, Applica+ion 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--------Rt. 2_BOA---4.6.Q_,x__AC&MgQ_ROo111er---Rd-....West---o __H1---Way_--99------ Geor a Fo Lodi 96018 Owner's Name-----------•---------------•-------------- ---••--g-------------.Ove Overton ------- -- Phone.-.-------------------------------- ---------------------- - ------------------------------- Addre Contra s-----------------------------------r' ---------------- A92P.,-e-___NQrth---F J.&e---IIP---COULeT_Rd+----------------------------- Contractor's Name -------------PA -SH-- & �JDIs � C -------------------------------------------------------- Phone__HO...69697 Installation will serve: Residence M Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ]------ Number of bedrooms ___Z__ Number of baths ----1- Lot size _15Q......X--8,X_851------------- Water Supply: Public system ❑ Community system ❑ Private E Depth to Water Table SQ__ ft.. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [N Hardpan E Previous Application Made: Yes E] No [X New Construction: Yes ❑ No ❑ Drainage 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__-_________- - aisting No. of compartments---------- ---------------Size---------------------- ---------Liquid depth--------------------- Capacity Disposal Field: Distance from nearest well_________________Distance from foundation--------------...._.Distance to nearest lot line__-_____--.-_____ ER at ing Number of lines-----------------------------------Length of each line----------------------------- Width of trench-------------------------- `t * Type of filter material_________________________Depth of filter material----------------------- length------------------------------------------ Seepage ______________________--____________-_ .Seepage Pit: Distance to nearest wel19Q-'_--------_----Distance from foundation-_l 1_____:__-.Distance to nearest lot line_ xx Number of pits------1-------------Lining materiaRx'I.Ck---------Size: Diameter__ p._______ - Depth- Cesspool: Distance from nearest well-----------------Distance from foundation_--_- ---------Lining material--------------- ____.__._ - ❑_ - Size: Diameter--------- ------ -- --- ------ _ Depth --- Liquid Capacity Privy: Distance from nearest well-.-. : ,. gals. . .� :� - ________ ._.__.___.-______-_-._Distance from nearest buildin g--- ------------------------------------- ❑ Distance to nearest lot line - =------------------------------------------- r - -------------------- Remodeling and/or repairing (describe):__.__*.__Ex stA_ng- l.e h-_-c� ix __has---b.eem---afat r_ce•-af___t_rotable_____ Burin r .._ any I c�_a or�-.----- w121__.be___nut.__.o-ff_-_fram___thi-e---dr-a1npoo-1..------------•------------- -------------------- - ---------------------I------------------------------------------- --------------------------------------------------------------------------•------------•- --------------- --------- I hereby certify that I have prepared this applica ion and that the work will be done in/accordance with San Joaquin County ordinances, State laws, and rules and regulations of t e San Joaqu}n Local Health District. (Signedl PARRISH & SONS_, .INC.#__..._ � �./ By-------- - ----- -�-' _ r ------------- ------------ (�aWContractor) -- - ------ - • (Titlel Estimator -- - (Plot plan, showing size of lot, location of systemrelationto wells, build' gs, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- --------- - ------ --- DATE--- -. REVIEWED BY------------------------------- --- /� --------- DATE- �� `� - �--•----------------------- BUILDING PERMIT ISSUED ---- ----- --------- DATE Alterations and/or recommendations______________ ------------------------------- ----- ---------------------------------- /--•-- -------------------•--------------------------------FINAL INSPECTION BY:... ...... ... 7 �~ .--- -1:71 '------------•---------- ----- Date----- - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E-9 -9-2M 145446 nrw000 iy-54