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° APPLICATION FOR SANITATION PERMIT Permit No. 1 TA 1 (Complete in Duplicate) 6_ Date Issued Applica+ion 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 O ina e No S49. Nord off' JOB ADDRESS AND LOCATION----lst. house ( e) 2533 Belvedere, Star Hame Ed. G. Robinson - - - --------------------------------- ----- Owner's Name --------- --- - --• -- -- Phone__HO__6839 - ---------------------------------------------- - Address----------------- - ?533 Belvedere ----•-.Belvedere ISH Inc. Ho 696.6 Contractor's Name = --------•-------• --. Phone-- •---------------------- Installation will serve: Residence 4.k] Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: 1_____ Number of bedrooms __.2_.. Number of baths . _____ Lot size ___50&__X-_150 t Water Supply Public system'Q Community system El Private ❑ Depth to Water Table __4'0- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay [] Adobe [@ Hardpan [] Previous Application Made: Yes ❑ No [?9. New Construction: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) None t Septic Tank: Distance from nearest weil_________________Disto 1fe fro�nl� fo nd�tion__ 0__------._.Mrial___CC Brick X3b X { No. of compartments.-Z__....-___--------Siz�--------------- ---- -------Liquid depth._— -----------------Capacity----9�---________-- Disposal Field: Distance from nearest well__Non -_Distance from foundatjs 0-�._______ Jr t r f s __....Distance to nearest lot Il e24 _________________ EXX Number of lines_________ Length of each line---- Width of french 0_ __---___-__-----_----- Type of filter material.__) _ .. Rk---Depth of filter material�8 _____________ Total len th____s_ ---______________. None 3p t ; Seepage Pit: Distance to pnearestw ell._.________.__._g..__Distance from foundation___•_______________. istince to nearest lotZli�e�_____-._________ Number of its----------------------Linin material--_._____ ---.__-_----Size: Diameter-----------.... ----_.--Depth-------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation------------------- material _._...._____.._._.____.___ - } _ ❑� 5ize:zDiamete _=------------ -------- - ----Depth---- ---------------------------- - - -------------Liquid Capacity_.. gals. Privy: Distance from nearest well-----_------------------------- _.___-------------Distance from nearest building-, ._-___.____----------------_ ❑ Distance to nearest lot line-------------- - - ----------------------- •------------------------------------------ ------------- Remodeling and/or repairing (describe)_____________________________ '_.------_--•----_ r ----------------------•--•-•----------•---------------------------------•-------------•- --------------{-----------------------------•---------------------•----------------------------•-----•---------------- ----------- ----------- ---------- ----------------------------•----------------------------------------------------------------------------------•--------------------------------------------- ---•--------•---•----------•------ ----------•--- - 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 Sa Joaquin Lac Health District. D • A. PARRISH & SON S , 1N (Signed) - ---------- ------- ----- --- - - ------------------------------------------------( 10 jW Contractor) By:----------------•.- (Title)----Estimator - (Plot plan, showing size of lot, location of system in rale+into wells, buildings tc., can be placed on reverse side). FORD ARTMENT USE ONLY APPLICATION ACCEPTED BY--- ---------------- ------------ ----------------------------------------------- DAT -y- --------------------------------- REVIEWED BY -------------------------- -- DATE ------ ,f BUILDING PERMIT ISSUED------------ ---- - DATE --------`�- - Alterations and/or recommendations:----------------- - --------- -- �\ ----------------------- —--------------------------- --------------------------- ------------ FINAL INSPECTION BY:--- ----- - -------------------------------- Date---- 4� .._ ------------------------------------ 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 E5�9-2M 145446 ATWOUD 12-54