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APPLICATION FOR SANITATION PERMIT Permit No. -- - -.. -- [Complete in Duplicate] . Date Issued/! � / �C �Applical-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 Ordinance No. 544. { 800 Blke So Rendon 1 Tentative No __o__801 -------------------------------- JOB ADDRESS AND LOCATION________________.r----__ __ . _ __ _ Ernie Joh�asont Plastering Contr, Tom Purinton Phone---2-405369---------- Owners Name ---------------------------•----------- - ----------------------------•-------------- Address--------------------------------------------------------1729 Su�ys�lae; stOak o21----.------------------ 1 ---- PARR.ISH INC --------- ---- Phone---------------------------------- Installation 'Name ---------------------------------••------•-------------------- ---------------------------- Installation will serve: Residence IX. Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __X___ Number of bedrooms _-A-- Number of baths ---1. Lot size ------Sa�_._ _ 1_. ___---------------------------- Water _.-___( 8>_____Water Supply: Public system [K- 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 ❑ No P4 New Construction: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank'or cesspool permitted if public sewer is available within 200 feet ` Se tic Tank: Distance from nearest wpZ.,ll-----------------Dista fir rrylioun�dation_ 'C ial CC_ Brick No. of compartments--------------------------$ize_ - _ _ Liquid depth- Capacity-n-0-0 -------- Disposal Field: Distance from near st well.' * --------- from foundation__-_19___._____Distance to nearest lot linel�.__._.__ Number of lines---- ----------- ---- --------Length of each line__.---30 t1IP-------Width of frenc�C_t-_-_2_'4'x_-----__________ Type of filter material___l�____-Rk Depth of filter material__________________-_--Total length___________-___________________-______-- Seepage Pit: Distance"to nearestiw�l__________----Distance from foundation_39.1..........Distance to nearest lot line---------,�_t_. Number of pits------------4 g ' -----------------------CC � �Size: Diameter------33"- --------De Depth---n---- - -- - -- -----n material0p - 1 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-----------------------------------------------------------------------------------------------------=--------------------------------------_ e Remodeling and/or repairing (describe):_!------ ---------------------- ------------------------------------------------------------------------------••-------------------------------------- ------•--------------------- ----------------------------------------------------------------- 3 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 San Joaqu' Local Health District. D. A. PARRIS So 1 ' ----- [ r Contractor) (Signed) -------------- - -- --------- Title ESt lat01'° --------------- - - - ----------------------------------------- [Plot plan, showing size of lo#, lata+' n of system in tela+ion to wells, din s, a+c., can'be placed on reverse side]. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------------------- ------------------------ - DATE---------- -- ,� ------------- ----------- == - ----------- REVIEWED BY--------------------------------------------- -------------------------------- -- --------- DATE---------------------------- ------_---------------------- BUILDINGPERMIT ISSUED--------------------- ----- ------------------------------------------- DATE--------------•---------------------------------•----------- Alterations and/or recommendations:- ------------------------------- ------------...---------------------------------------•------...-------------------------•--- ------------------------------------------------ -----------•------ ------------- ------------ ------ - ----------------------------- -------------------- `"` ------------- FINAL INSPECTION ------------ Date__,..- . "� 1. 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 1 ES-4-2M Revised W-2100