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APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Permit No. 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. 268 South Adelbert Street JOB ADDRESS AND LOCATION------------------------------------------------------------------- Jack Castleman HO 3-9744 Owner's Name --------------- -•-------------•-----------•------------------------------------------------------------------- Phone ------ --------•- ----- Address------------------------------------ame...as- above Parrish Ing Hn --- 6::9 07 ---- Contractor's Name------------------------------------------------------------------------------------------------------------------------------------------ Phone---- ------•--_-------- Installation will serve: Residence [?' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of livingunits: -_ 1__ Number of bedrooms __-___-_ Number of baths -------- Lot size ---- __®� ©f 2 1 5 Water Supply: Public system EIC Community system ❑ Private ❑ Depth to Water Table __�o ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ® Hardpan ❑ Previous Application Made: Yes ❑ No [2 New Construction: Yes ❑ No ® FHA/VA: Yes ❑ No ❑ 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 --------------- ._-__-_---:__-•-.--__.__-_--____-. G r se trap No. of compartments-----------------------Size--------------------------------Liquid depth -------------------------- Capacity ----------------------- Ex ting Disposal Field: Distance from nearest well ----- NOne_ Distance from foundation _ l �______--.Distance to nearest I t I��e..__5'________ KI Number of lines -------- �,__--s_-_rO��___Length of each line _________��8�___._.__.Width of trench.____4Ot_____________________ Type of filter material ---- ___________________Depth of filter material__ -_____._._______-____Total length___--...__.._...._........__..__._..__.._. Seepage Pit: Distance to nearest well ---------------------- Distance from foundation .................... Distance to nearest lot line ___---__-__._____ ❑ 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 _______________-__________---__-___-_. ❑ Distance to nearest lot line ----------------------------------------------------- ----------_----- ---------------------------------------------------------------------- Remodeling and/or repairing (describe):___T ___Serve kitchen sink only ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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. (Signed) Parrish Irina ------------------------__---_______---_-_-___-- Owner and/or Contractor (Sig ) h ( / 1 By: Bill Wright---------------------------------------------(Title)---------------------------------------------------t -- ---------------------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - - ---------------------------------------------------- ----- DATE 3 ---------------- ---------------- REVIEWEDBY---------------------------------- - - - ------------------------------------------------------ DATE------ --- BUILDINGPERMIT ISSUED ----------------------------- --------------------------------------------------------------- DATE ----------------------_._...------------------ Alterations and/or recommendations-------------------------------------------------------------------------------------------------------------------------------------------------------------- -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------.............................................. ------------------------------ /c- ---------------------------- ------------------------------------------------------------------------------- FINAL INSPECTION BY:---- �----.. ----- - Date-- L- . -7 -------------------------------------------- j 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. 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