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# FOR OFFICE USE; T ,r 4 .• ------------------------------------- -- --- APPLICATION FOR SANITATION PERMIT Permit No. ... 3�_ _.. ------------- --- ------- ---- - ------------------------ (Complete in Duplicate) Date Issued ___ --------------------------------------------__------- This Permit Expires 1 Year From Date Issued 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---------------------1728--E---Demano-------•-•--------------------------------------w------------------------------------------------------------ Dr. V'ir 1 Giannli Owner's Name ---- - . l- --------------------- -------- - -------- -- ------ Phone..--•--------------------- .1728 El Camino k Address------------------------------ - ----------------------------------_---------------------------------...--------------------------------...---- -------------------------------------------------------------------- t D.A. Parrish & Sons Inc. u ContractorsName------ -•-------------------------------•------••-------------------------------------- ------------- ------------------------------------ Phone------------------------•------ -- Installation will serve: Residence K] Apartment House ❑ Commercial ❑ Trailed Court ❑ Motel ❑ Other ❑ f Number of living units: -_..- Number of bedrooms ____. Number of baths-_ffl-ot size ........&OOTage---------------------------- - Water Supply: Public system ® Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 fee+: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe® Hardpan ❑ Previous Application Made: (If yes,date--------------------1 No [a New Construction: Yes ❑ No E] FHA/VA: Yes ❑ No ElTYPE 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--------------------Material------------------------------------------------ EIM3TING oundation-=_---_---___--.Material----._____.__------------------------------- EIM3TTNG No. of compartments--------------------------Si;e---------------------- 4-..Liquid depth------------- - -Capacity---------------------- \ Disposal Field: Distance from neare t well...2QQS.--.-Distance from foundaf.i. _-_-_ !._ Distance to nearest o line-_25t------- V -- --- 8� � 5� 24 Number of lines----------------------/ -------_--Length of each line----____--f_______s._._---:'Nidth of trench--------------.--------------------- Type _ --�- __--- Type of filter material_-_---.SA------._-Depth of filter material......1$1-------..Total length--------1501-----____-__-___---_- Seepage Pit: Distance to nearesf well----------------------Distance from foundation---------------------Distance to nearest lot line--..-_-------..._ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter.---------- -----Depth--------------------------------- Cesspooi: Distance from nearest well-----------------Distance from foundation--------------------Lining material-----------.-------..----------__----. ❑ Size: Diameter-----------------------------------------Depth------------r--------------------- - ---------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building.----____-__----___.-----_-----.----_- ❑ Distance to nearest lot line - --- ------------------------------------------------------------------------------------------------------ ---- ---------- Additional. 150s of leach Remodeling and/or repairing (describe)-------------- - - - - ------------------------------------------------------------------- ----- __.________.------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- q S ti `. I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State I ws, and rules and regulations of,the-San Joaquin Local Health District. Sined - Y ------------ --- -------------��-- ----- -------------------------- --------- Ow er and or Contractor g } / ) By:------------- •- � --fir-------------------(Title).- '--------- --- -------------- (Plot ---- (Plot plan, showing size olot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY /, APPLICATION ACCEPTED BY ------------------------------ DATE `� ------------------ REVIEWED BY------------- ------- ------- - --------------- --------- DATE-------- - ------ BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE-------------------------------------------:----------------- Alterations ----- -- -Alterations and/or recommendations:---------------------------------- - a -------------------------------------------------------------------------- --------------------------------- -------------------------------- ------ --------------------------- ----------------------------------------- ---------------------------------- ---------=---------------------------------- ------------------------------------------------------------------------------------ --------------------------- ---------------------- FINAL INSPECTION BY: f2... _ . ��-Kms(--- -- - -- --- ------'---- -- Date. - -- -----6----r--�---------- - -- ------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ! ,. r-P.c o.