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I1a�5� r ��•' APPLICATION FOR SANITATION PERMIT Permit No. ..�� .:. (Complete in Duplicate) 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------d.lib,X3:__An.clahl--------------1 19...Z._.-A.C.&CU---fit...----•.................................................. ---- Owner's Name-----------------------------------------8-1.9..B..-...&Z&C_1.4...$:t- _. Z-oh-n--ArWahl------------=---: Phone.....HO...51+6....... Address Parr•ish...la ----- •-•--- •-- ....................... ..•..::. ....:.. ........ . ......... ......... Contractor's Name-----------------------Pair•Ti.Sh__A-S-fJns...Ina-_-------------- ------ •---- •--------------_----..'. Phone... Q...6.96.0. .-- Installation will serves Residence U Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms 2____-Number of baths .1.:_. Lot size -...50t _-x._.125-1:.. ...._................ Water Supply: Public system XX Community system ❑ Private ❑ Depth to Water Table ...5.0 ft, Character of soil to a depth of 3 feet: Sand❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[ Hardpan ❑ Previous Application Made: Yes ❑ No [Z New Construction: Yes [] No ❑ FHA/VA: Yes ❑ No ❑ Supplementary TYPE OF INSTALLATION AND SPECIFICATIONS: Dftine (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_________________Distance from foundation_--____-_-__.__.__.Material ._......_ .......r. ---_-- EOLsting No. of compartments---•----------------- ----Size___.._....--_-...__...........__Liquid depth-- _--:---:...___._Capacity.....__ '-------- Disposal Field: Distance from nearest well--- .from, foundation__-_:_22 s._._.Distance to nearest lot Ii�e-------- �.. jTtt�ng Number of lines---------1 t _...iength-_of each line..... �d--___ Width -bf trench ` 2 Type of filter mate ria l..S_ep_,___�lk__.Depth of filter material.......18r.._._,...__Total length......2U!... ............... Seepage Pit: Distance to nearest well None__._Dist`an,a_from�o undation---12 __.Distance to nearest lot liner tE o t ing Number of pits----1__-_-_-_-.__Lining materialR-0--c :__;------7-Size: Diair er_- ____Depth___ ._ ��. .. Ges p ol: Distance from nearest well----------------- om � unclation.__ '_� ----Lining material F-1 Size: Diameter______-____- Depth y - } --------------------- _ Liquid Capacity gals Privy: Distance from nearest well --__i_-_ ___- Distance froom dearest building ❑ Distance to nearest lot finet Ik v Remodeling ............................... and/or repairing (describe):---- ;---------- -------- -•------ _- - - ----- -------- •-------- .. ----------------- ------------------------------•-------------------------------------------------------------------------------...................... '�_ I hereby certify that I have prepared this a ron arrd'ttfaffhe work will be done in accordance with San Joaquin County ordinances, State laws, and rules and' regul Ws,,of the San Joaquin Local Health District. Sr ned PARRISH__&-SON S---INC:.-... (Signed) antractor) By:....-......................................... -- ------ --------JQHN..Dj&Y--_---------------- (Title).....t0TKAT-QR-------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT US_E-ONLY APPLICATION ACCEPTED BY ,,.- DATE RE-44EWED Br------------ -- -- ----- --_ -- ------ ------ -------- -------- ------------ DATE-----•-- BUILDINGPERMIT ISSUED. •..........•------ =------- ---_----------------------------------------- DATE. .._...., .......... -----•. "d' Alterations and/or recommendations ------ ------= --................. ------ --•--- ........................ -------.............. ... - -.------- K- --- ---- --------------- ------------------------------- .......................................................................................................... FINAL INSPECTION BY:----' ""G ( ----------------------------------------- SAN - ------ •------------•---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 . Revised 1.57 F.P.CO.