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APPLICATION FOR SANITATION PERMIT Permit No. ..... .�- _..:. (Complete in Duplicate) Date Issued ___�p_________________ 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. at Moreing Rd. & cross to Isle. JOB ADDRESS AND LOCATION Atherton Island. . , turn left off Country Club Blvd. j - ------------------- Owner's Name_______________ Beardsle , Genl, Contr, C. C. Hoffrnan� -------- --- - Address2269 E, Miner Ave. ----------------------------------------------------------------------------------------------------------------------------------------•----------------•--•---------•-••-- Contractor's Name--- ..............Parrish_Inc. 9P9607 - --------------------------------------------------------------------------- Phone ------- ---- - Installation will serve: Residence.0 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ____l.___ Number of bedrooms .__3----- Number of baths .2___. Lot size ___.1____.�________lus____acre_ _ _ -------------------- ______ Water Supply: Public system ❑ Community system ❑ Private 2@ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay 6 Adobe[N Hardpan ❑ Previous Application Made: Yes ❑ No)f] New Construction: Yes X] No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Y Septic Tank: Distance from nearesT w II--60:.-_____Die ante from foundation..10_;_____._.. nal___ et81 $] No. of compartments__-__�_______-___.__-_Siz 8"OD_ teach. Li -------- Liquid de th__��-_. Ca Capacity 1128 Ga1se » p. ---- P y----------------•-- 60 � deep each r Disposal Field: Distance from ne est well_________________Distance from foun 10 _ Distance to nearest I line___-___._____.... Nc `� 2�+ Number of lines-3 Distance Length of each line___:_____-_ --____-____.Width of trench __-y _.__-_____-_________-__ Type of filter material_________________________Depth of filter materia l-----_ -_-___-___--___Total length__ __-5.--------________-_______--__-_ Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line----------------- 0 Number of pits----------------------Lining material-------_---------------Size: Diameter----.------------------Depth---------•--_-------------------- 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------------------------------------------ El Distance to nearest lot line----------------------------------------------------------------------- Remodelingand/or repairing (describe):------------------------------------------------------------------------------------------------ ------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work wi be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local H Ith District. Parrish Inc, , , ( r Contractor) (Signed) ------------ ----------- ---------------- -----------------------------'------------------ GUW By:...................................................... ( ) Estimator --- ---- --- ------------ Title---------------------------------------------------------------- (Plot plan, showing size of lot, location f syste n re a ion to wells, building etc can be placed on reverse side). OR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.--• ------------- DATE_ l REVIEWED BY-------------------------------- - --- -- ------------------------------------------------------------------------------- DATE------ �---------------- BUILDING PERMIT ISSUED-----------_------------------------------ ----------------•----------------•---------------------- DATE------- Alterations and/or recommendations------------------------------------------------------- - ---------------------•--------- __•---------------------------------------------------------------------------------- ...............................................................•------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ----------------------------------- -------------------- --------------- ---------------------------------------------------------------------------------------------------------•----_ /�� FINAL INSPECTION BY:. Date------7- 73 _-� ----- ----------------------------------------------- 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 10-52 Revised W-2100