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� .� �C � � APPLICATION FOR SANITATION PERMIT Permit �- 5 (Complete in Duplicate) 9 • � , Date Issued 16 " 60 A 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-----X137 E. CRRXx---- - E,----Fremont---StreEt---------------------------------- -- Owner's Name _..__.... *CSIII le E. VillarOri --------------------------------------- Phone------------------------------------ Owner's Address---------------------------------------------- ----------•-----------------------------------------------•----------------------------------------•---------------------------------------------------..---- D. A.. PARRISH SSONS INC Pone---�` 9��-- Contractor's Name----------------__----• - - -- r __--_ ----------------------------- Installation -` -------------- Installation will serve: Residence] Apartment House [X Commercial [❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:2_______ Number of bedrooms A____.Number of ba+hs2_____ Lot size .405________ ______________________---------------- [ Water Supply: Public system ® Community system '❑ Private 0 Depth to Water Table .------- ft. I # Characfer of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 8 Hardpan ❑ Previous Application Made: Yes ff No ❑ New Construction: Yes ❑ No ❑ Supplementary 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--------------------Material------------------------------------------------- Existing No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity----------------------- Disposal Field: Distance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line__________- PKI0tIng Number of lines--------------- -------------------Length of each line------------------------------Width of french-_-----------------.--------------- Type of filter material-------------------------Depth of filter material-----------------------Total length------------------------------------------ None _______________________________---------- 10 �5f Seepage Pit: Distance to nearest,yrell_N� e________Distanc r fou d - e: D __------------Distance nearest lot Q_1---___-_ _ _______ Number of pits-----------------------Lining material" riC ize: Diameter----- -- 5---.Depth---3�-------_-•-------------- Cesspool: Distance from nearest well-----------------Distance from foundation---------.---------.Lining material_____-__-__________________________.. ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well________________________ _____________________Distance from nearest building-------_._.._____________---_____________. I ❑ Distance to nearest lot line_____________________-_________ FRemodeling and/or repairing (describe)--------------------------------.------------------------------4---------------------------------------------------------------------------------------- 1' ------------------------------------------- F --------------------------------------------------------------------------------------------------------------------------------------------------•---------------------------- ------------------------------------ -------- •-•- ---- ------- --------------------------------------------------------------------------------------- ------------------------------------------------------- -- 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. Do PARRIES S9___ G _ �� Contractor) (Signed) ----------- -- `------- _ r -� Estimator SY� ------------------------------------------(Title) (Plot plan, s ize of lot, Iota i �syonm in rela '' to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------__--------- --- - - __ DATE______1'q__ `"'�� REVIEWEDBY----------------------------------- ------ ------- --- ------------ ------------------ -------------- DATE------ --- ------------------G�'-- - -- BUILDING PERISSUED------------ ---------------- DATE- Alterationsant!/or recommendations---------- ----------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------- --------------- --------------------- -------------------------------------- ------- - ---------------------------------------------------------- ----------------- ---F -------- ------,--------- ------------------ --------------- FINAL INSPECTION BY-------------� - -------------- 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 ES--9-2M B-51 Revised W-2100