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APPLICATION FOR SANITATION PERMIT Permit No. _-/l_--�1r 7_ (Complete in Duplicate) r'04/ Date Issued -------(-ff---' 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. 2'719 East Poplar � JOBADDRESS AND LOCATION -- -----------------•-------------------------------------------------------------------------------------------------------------------------- Owner's Name------------------RelLnO--PO-robich --------------------------------------------------------------- -------- Phone----------------------------------- Address �2� North--Golderi Gat ------------------------------------------------------------------- 6--- - --- -- ---- Parri sh Inc HO —9 d7 . Contractor's Name-------------------------------------------------------------------------------------------------- ------------------------------------------- Phone------------------------- --------- Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel Other ❑ Number of living units: ___1 Number of bedrooms ___2__ Number of baths _1___ Lot size ----_5x20_ _____________________________________ Water Supply: Public system 761 Community system ❑ Private ❑ Depth to Water Table 40_ ft. Characterof soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 1A Hardpan ❑ Previous Application Made: Yes ❑ No ® 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 welF""---Distance from foundation--------------------Material_______________-__--_____________-------------_-- Ex 40 i ng No. of com artments--------- ------------Size_-------------------------------Liuid de th-------------------------_Capacity Disposal Field: Distance from nEaresiwefi__ One ._Distance from foundation_ 0�___---_---.Distance to nearest l 4ne_�Q____-____- K) Number of lines___________________________________Length of each line__-----___-__ Width of trench.._ _ --- - _____-_________ s rock $ ------ �� 0 Type of filter material_____ ___ _______:__Depth of filter material____.______________-__Total length------------------------------------------ '4 Seepage Pit: Distance to nearestivell____nOn4 DistanceAosifoundation $0---.------Distance to nearest lot line__________ nNumber of pits----------------------Lining material--------- -----------Size: Diameter--------3-3---------Depth------25--------------------- Cesspool: Distance from nearest well-----------------Distance from foundation___________________ Lining material-------------------.____-____________ ❑ Size: Diameter'------------------------- -----------Depth---------------------------------- -----------------Liquid Capacity----------------------------gals. r\ Privy: Distance from nearest well---_---------------------------------------------Distance from nearest building_____-______________________--------___-_- ❑ Distance to nearest lot line----------------- - ------------------------------------------------------------------------------------------------------------------ Remodeling and repairing (describe): ;� ------------------- h _______________________________________________________________________________________________________________._______---__--__________________________________--_________--------________----____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. Parrish Inc (Signed)----------------------------•-------------------------'--`-----------------------------------------------------------------------`=------------- -------- (Owner and/or Contractor) etBy: Sill Wright Met- By:---------------------------------- -------------------------------------------------------------------------==--------------- --------------------------------------(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-------ra- _5_7----------------------- REVIEWEDBY--------------------------------------------- --- ------------------------------------------------------- --------- DATE------------------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------- Alterations and/or recommendations:---------------------------------------- ------------------------------------•-•--------------------------- ------- ---- ------- ____________4-,_J- _____-_6 . --______-FIMS-_L_____-____1' `_.-._ _ "f.Ll-------- `x-_._____'�"=_R_9'__.______IQ.-/_�____��._________ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ f---------------iR- ------------------------------------------------------------------------------------------------------------- -------------------------- -------------------�------ -f--------- ----- ------------ --1-------------- --------------------------------------- --------------------------------------------------- L ------------------------------------- FINAL INSPECTION BY: -- Date----- ------ -- 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-9-21A , Revised 1-57 F.P.CO_