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qc � APPLICATION FOR SANITATION PERMIT Permit No, .L.� - ------- (Complete in Duplicate) / Date Issued /S - Application is hereby made.to the SanlJoaquin 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---- _G�Ckt.l7S�------------------- -------- Owner's Name--------- ------------------ " 6 , -- AddressPhone__HD - -- ---- ----_.-----•------•• --------------------- -------Same ----------• ------ - ------- ••------------------------------ Contractor's Name-------------•- "PAIH__& _ODI - ----Ii�IG - r = = _--_�- = ------------------- Phone---lio---b9607-- Installation will serve: Residence-EXXApartmen t House ❑ Commercial E] Trailer ❑ Motel Court El Other Number of living units: __1.' i of bedrooms ---2-- Number of baths -------ILot'size ---65!_X--- _-5t Water Supply: Publics stem 'Private' *r " Y �$ Commun`ity system ❑ [] Depth to'Water Table _-35tft: Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam 0 .Clay Coam❑ Clay ❑ Adobe❑A Hardpan ❑ Previous Application Made: Yes ❑ No ® New Construction: Yes ❑ No ❑ Fl-IA/VA; Yes ❑ No [X Replacement TYPE OF INSTALLATION-AND SPECIFICATIONS: , (No septic tank or'cesspoof pe'rrriitted.if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-__NOne:Distance from fo�-�Z0- � No. of compartments___ ____-2_-_ ___--� :Size_ Fl TT q . -p' rt z -�--- 5— _6-- ---_ Li Liquid de th - $---- -- -----Ca acit Disposal Field: Dista ce,from nearest weft .-.X6XI.e_.Dista ce� om fo �dation-----1Q---------Distance to nearest lot & _. line___ �t ff EEC Number of lines----- ------------- -- = Length of each line- -:-........ Qt_.-. Width of trench-------_---- Type of filter material,"-.-$Q��-- -=Depth of filter daterEal---`1$ ...........Total length-------------------504 t.x + Seepage Pit: Distance,to nearest well_- QIIB_=x__Distance from foundation= ]„ST:..• Distance to nMx earest lot line______5 ___ _ Number of pits--____�___�--_ -_:Lining material-BQC.j -+ -__-Size: Diameter-____ rr 20 t P - _t 33'- De tn- p Cesspool: Distance'Jrom nearest well_______________`Distance from foundation____-___;__J___--.Lining material------__-_____--___.______- 9❑ Size: Diameter = Depth .= - ----Liquid Capacity --------- ----- al" Privy: Distance from nearest well_______________________ '_._Distance from nearest building O .4-- 9 - ---------------------------- --- e' -- - -------- - ------------------------------------------------1.......... is ante to neares}'lot fin f - - y.a. 4 _ ( ------------------ ---------- Remodeling ---- ------ -- .. . } I - . .h I _ _ ' � - i Remodelin - ------------ - . . --------------------------------------------- ------------ g p _ an or re arm escri(describe).-----_-' .r --------------•-•------•----------•- - --=--- ----------------------------------.--------•--------- ---------------------------------------------------- •------ s ---------••- ____-___•____ _-------------------__________.__-__ � R� _ .F- -. -------- - 1 � s , • -------------- hereby certify that ( have have-Ore' pay d thi pplication an at he work will be done�in accordance with San Joaquin County ordinances, State laws, and rule and r gulat ns of the an o in Local Health District. (Signed)•-------PARRISH--- � ` " ------------------ ( Contractor) By: ----•---------------------------------- - ------ - ` -- ---- -------- - -• --(Title)---Erstimat_UI°- ----------------------- (Plot plan, showing size of lot, locatio of i yste in.rela on to well 'buildings; etc.; can be placed on reverse side). FOR ARTM T USE ONLY REVIEWED BY - - -----..---- �-` DATE. �'. APPLICATION ACCEPTED __ _-___----- - ---------------------------- -------------- BUILDING PERMIT ISSUED - y ' ------ DATE---------- - -•---------••--------•------------------ Alterations and/or recomm�dPoatioras------- ---- ----- --------- DATE------- - - - - ._ rte--"T- , ______________________________ -- .-_____.___.____.______. .-_ ___-_____--____-______ 1 ' ______________ , 1 _________________________________ i FINAL INSPECTION BY:---- - ="---- .�=-- - _, �..._ .r .. ._ f --- Date_ SAN JOA v UIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Mentees, California Tracy, California E5-9-2M Revised 1.57 F.P.CO_