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0�01aV� APPLICATION FOR SANITATION PERMIT Permit No. _-_.L/_-x`33_ [Complete in Duplicate] Date Issued _�bhf- 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-----------7503*__Pacific Avenue - - - - --- --•---------------------------------------------------------------------------------------------------------- Owner's Name-------- Bili. A-rmanino------------------------- ------------------------------------ - ----------------------- -------- ----- Phone--------------------------------•--- Address_______ 1428 North Madison' --- . --- ....-�--- ---..s- ---•----•---------------------------------------------------- ------------- ------------------------------------------------- --- ---- ---- Contractor's Name__----.Parrish TnC. HO ^° 07 - - --------------------------------------------------------------------------------------------------- ------------ Phone-----...-----------------•--------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ® railer rt Motel E] Other ❑ Mte1 &�(om9 Number of living units: -------- Number of bedrooms -------- Number of baths _ _-- Lot size ____.._____________________-______________________---____ Water Supply: Public system 91 Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ® Hardpan ❑ Previous Application Made: Yes ❑ Non New Construction: Yes ❑ No [!9 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-----------------------------.___-----_________- ®xi'sting No. of compartments----------nOne------------- Size--------------------------------LiquiOPth---------- ---------------Capacity------------5-f------- - Disposal Field: Distance from neare�t well----------------- Distance from founelatior ,+-____________.Distance to nearestIptIli ne____-___--_____-- 44 Pq Number of lines-----------------------------------Length of each line________J____- Width of trench.__ _ _ Type of -Filter material.....ro-Ck--------Depth of filter material-_. ------------------ length--_____1 �t_ ------------------ none ____________--__ O E i Seepage Pit: Distance to nearest Lyell-------n�11------Distance frOorCr foundation______ ____-_-.i ce to nearest lot Lrin_------__--_-__._ Number of pits-------- -----------Lining material---- - --------------Size: Diameter-----------------------Depth------------ �-------------------- �i Cesspool: Distance from nearest well----------------- 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):--------------------------------------------------------------------------------------------------------------------------------------------------------- J - - - - ------------------------------------------------------------------------------------- ------------------------------------------- -------------------- -------------------------------------- 1 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. Parrish Inc (Signed) ---------------------------- --------------------------- ------------------------ -- ---- ------t---------------------------------------(Owner and/or Contractor I3 : Bill Wright Est Y ------------------ - - - --- - - -------------------------------------------------------------------(Title------------------- -------------------------------------------- (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------ 0 ------------------------ REVIEWED BY-------------------------------------------- ------------------------------------------------------------------------------ DATE--------------------•-------- ---------------------- BUILDINGPERMIT ISSUED--------------------------------------------------------------------------- -------- ----------------- DATE-------------------------------------------------------- - Alterations and/or recommendations:----------------------------------------------------------------------------------------------------------------------------------------------------------- -- ----- ---------- f r -------------- - --------------------------------•----------- ------------------------- s ----- -----------------------------------------t Ta D.P4 --------------'-�— �f} - cU n K. ------------------- ------ ------------------------------------------------- J �P ------------------------------ --LNBY: ------ �11 ------------- -------- ----- ----- - --------------------------------- ---------------------------------------- -------------------------------- .. FINAL INSPECTI Date------� --T --------- 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-