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60 APPLICATION FOR SANITATION PERMIT __ _ . Permit INQ. - ` 1 1 (Complete in Duplicate) Date Issued I Application is hereby made to the San Joaquin Local Health District for a permit to construct and insta[I the work herein described. This application is made in compliants with County Ordinance No. 549. JOB ADDRESS AND LOCATION___!________ �-_4___-a��? Avenue -- - ----- Henry Konechney Owners Name------------------------ --------------------------------------...----------------------------- - Phone-------------------------------- -------------------------------------------- --- Address------------------------`----------1g4Z,--Ethan Way------------.-•----Sacramento,California----------------------•- ---------------------------------- D AJarrish & Sons Inc. HOb-9607 Contractor's Name -'--.•---------------I------------- - Phone.. Installation will serve: Residence ® Apartment House � Commercial E] Trailer Court El Motel Other E] Number of living units: _------ Number of bedrooms ________ Number of baths �__-_- Lot size __,_�_ X� Water Supply: Public system [jj Community system ❑ Private [] Depth to Water Table Ant. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ® Hardpan ❑ Previous Application Made: Yes ❑I No;® New Construction. Yes ❑- No ® FHA/VA: Yes 0 No ❑ I TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Sg ---1 ' l -------------- ptic Tank: Distance from nearest well , Distance from foundation'_-------_-----.----.Material------------------------------------------------- Exx Ing No. of compartments--------------------------Size--------------- ----------------Liuid depth--------------------------Caacit Disposal Field: Distance from nearest welf_j\f_pnP_.___.Distance from foundati2n010t__________Distance;to neares�(ottline_-_ZQ_.._---_ ] Number of lines_____1-_--------_--____-.__.__Length of each line___________________i_______._.Width of french------- _j k _j Type of filter material-_-T'OCk__________Depth of filter material____1 8-----_______Total length----------_ �______________________ CA r 2 t Ot f Seepage Pit: Distance to nearest well___N�ne________Distance fr�mCCQundation________5______._..Dis{�gc1g to nearest 1ot21�9_-_-.._________ ® Humber of pits.�-------I----------Lining material-------- KK .Size: Diameter------------------------Deplh_------.------------------------ p Liquid Capacity - gals Cesspool: Distance from nearest well_________________ 1 Y Lining material--------- ------------------------ _. I Size: Diameter_ .- -_.-_-_ De Distance from foundation.=.------------ - I Privy: Distance from nearest well-_________________ ____----------------------Distance from nearest building_____________________________ ---------- ❑ Distance to nearest lot line--------------------------------------------- -----------------------------------•------------------------------------ ------------------ Remodeling and/or repairing (desc be):--------------•---------------------------------------------------------------------•--------------------------------------------------------- I ----------------------------------------------------------- I= --- - I -------------------------------------------------------- --- ----------------------------------------------------------------------- ------------------------------------------------•------------ ' 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. . D A Parrish & Sons Inc. (Signed) --------------•------------------------------------- ------------------------------------�--•------------------------------------------------(Owner and/or Contractor) ------------------ Bil.l Wl'iht Tit) By:------------------------------------------------- ------------------------------------------------ (Title plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). i FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY--- --------------------------I---------------------------------------- DATE------- �---------- ----------------- REVIEWEDBY----------------------------------- ------------------------- ----------------------------------------- DATE--------------------------------------- BUILDINGPERMIT ISSUED------------- ------------------------.------------------------- --=---------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations:----f- _ y"' " ! --------------------------------------- /. e• " ------------------------------------------------------�--� -----�---------,-J--r-=-,----------�- - . / - � e_,� _----�"'"-=----------r --- - " , -- .x-e..r-R- . ------------------------------------------------------------I --------------------------------------------------------- -------------------------------------------------------------------------- i ;I ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I FINAL INSPECTION BY::---er-. ....... --- Date ` s 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 Revises 1.57 P.P.CO.