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APPLICATION FOR SANITATION PERMIT " Permit No. ----- Com lete in Duplicate) _ [ P Date Issued __ Application is hereby made to the�an-Joaquin Local Health Districf'for a permit to construct and install the work herein described. wa This application is.made in compliance with County Ordinance No. 549. + JOB ADDRESS AND LOCATION------3022No-•---Vit ,---Waw------------------------- Owner's Name--------- °T+ Daa ' ------------------ ----.-. :----- Phone HO_ --- -- 7----------- Address-----------------------S_ame---------port_:S_�tack_t-cn---Auta...Cmuit------------------------------------------------------------- .,Contractors Name------------ & 1----TUC-•------------------------------------------------- •------------------ - Phone----H¢---�_a-_60f---- Installation will serve: Residence 0 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel 99 Other ❑ Number of living units. ____ I Number of bedrooms _3___. Number of baths -- _._ Lot size --150 I_ ,�O -X._ O'_ -•----------------------- Water Supply: Public system)a Community system ElPrivate ElDepth to Water Table _5Q_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [] Clay Loam ❑ Clay ❑ Adobe mc Hardpan Previous Application Made: Yes EKNo ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No [X n TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearesf well-----------------Distance from foundation---------------_____Material --______ 1 Exil9ting No. of compartments--------------------------Size---------------------------------Liquid depth--------------------------CapacitY ---------- - Disposal Field: Distance from nearest well---T1TQ 2__.Distance from foundation__ _fDistance to nearest of line-----10 Number of (inns------- -------------------------Length of each line---------- -----------------.Width of trench it ----------------------- Type of filter material__ e_P_t.a,C-----Depth of filter material___-1$f T.__- --_Total length____ O_E______________________________ Bgock -� _ l` Seepage Pit: Distance to nearest well__Td_Qx1E_______D�sta c from o dation__-..__a �___- Distance to nearest lotline______l [XX Number of pitsi---1--------------Lining mate jal----Rock_- _..Size: Diameter------,33-----------Depth___....__5---------------- Cesspool: .__________- ---- �'' P ) -------------Di ante fr oundation-------------------.Lining material-----_--------------------=---------_ N [] Size: Diameter-fi-------------------- ------------Depth------------------------------- ---------=-----Liquid CapacitY---------------------------•gals. ass oo : Distance from nearest well____ Privy: Distance from nearest we]_-----------------------------------------------_Distance from nearest building_____-.___.-_______.______-_ ❑ D-istance to neatest lot line--------- -----�-- -- ----------------- --------------------•----------._ - ---------------- Remodeling and/or repairing fdescribe)_________________________________________________________ ------------------------------------------•-------------•-----------------------=------=-------------=--- ----- -------------------------------------------------------------1-------------------------•-------•--------- ------- ----------------------------------------------------------------••------------------------- ..--------•------------------------------- -----------------------------------------------------------------------------------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 regulations of the San Joaquin Local Health District. [Signed}_ P.ARRISH do SCI'TS '-___INC_,,'_.____ -- ----- - [ r �Contract ) --------------- ----------------- , -- � --- yr ---- ------------- ------ ------------------------- BY:_------------ = ------ --- - --------- -- -- ---- -----------(r+lel Estimator (Plot plan, showing size of lot, location of system in.rel ion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- ------------- -`--- -------------------------------------------------- DA E-------�: REVIEWED BY - ---------- -------------------------- -------- -------- -----•�------------- -------------------------------------•-------- DAT --- ---- BUILDING PERMIT ISSUED------------- ------ -- ----------------------------------------------------------- DAT -- ------ -----�------------------------------------- - ---- ------------------------------ Alterations and/or recommendations:______ ___ _____ _____ _ E "?° -- - ---- -- - ------ _ ----- ----- ----�$ ------- � ._. _ ------ PC--_:..... .:::___----•--------------------:-::: -� -------- _______ _ _______I.._______.______.______.___- -_.._____________._ •_______________ ._ + a FINAL INSPECTION .BY------ -------- ------------------------- Date------------------- �----- -7 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 ES-9-2M Revises 1.57 F.P.CO.