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APPLICATION FOR SANITATION PERMIT Permit No. _l -- r- D1b (Complete in Duplicate) Date Issued ______--'��--- 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-------------3,b7- S-o_uth_-Sinojair---Str_eet------------------------------------------------------------------------------ Owner's Name------------------ E ' --------------------------------- ---------- --- ------------------------------ Phone.-H03---1-1-9-0---------- Address------------------------------SAMA... __ -------------------------------------------------------------------------------------------------------------- 9 ------ Contractor s Name----------Par_r_iSh -$c-- -�tll�S__-- C______________----------------------------------------------------------------- Phone--Hp•--6-9b07 - Installation will serve: Residence & Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ 80' x x.20' Number of living units: __1-__ Number of bedrooms __2___ Number of baths '___-_ Lot size80x Water Supply: Public system [4 Community system ❑ Private ❑ Depth to Water Table __45 eft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [N Hardpan ❑ Previous Application Made: Yes ❑ No [X New Construction: Yes ❑ No F] 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 --_____--__p._ -_. - t ---- - - Materia--------------- - - -- --------- ------- Exigling No. of compartments--------------------------Size--------------------------------Liquid de th---------- -------------- Capacity -•- None t Disposal Field: Distance from nearest well- _.._.Distance from founda#i-on_____10___._-__.Distance to nearest ot�iline..-_�_________. � `+� 50 Width of trench__ 2� ------- �+ Number of lines ------------------------Length of each line - ------ ZF-- T------------------ Type rOG�---Depth of filter material-------- g---------Total length--------��---------------------------- Type of filter material-__--_______ 1 None 19 t'Seepage Pit: Distance to nearest well____________________ _Distance from foundation___.____________.__.Dsstan�? to nearest lot line__t_ _______- Number of pits-----= ------------Lining material___--rock------Size: Diameter----•-----33__--__-.Depth----------- ��---------------- [ 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------- ------------------------------------------------------------------------------------------------------------------------ ----------- 'Remodeling and/or repairing (describe):----------------------- -------------------------------------------------------------------------- -------------------------------------------------------------•------------------------------•--------------••----------------- { --- -------------- ----- --------------------------------- ----------------------------------------------------------------------------------------------------------------------- f --- ----- - - - I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County l ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. d Parrish & Sons Inc. ---------------------------------------------(Owner and/or Contractor) tSineg )-------•------------------------------------------------------------ --------------- By-------------------••Bill_Wry-ght- ------------- ---------------- -------------- -------------- ----------(Title)----------F--Pt------------------------------- -------------- (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 APPLICATIONACCEPTED BY-------------------------------------- ---------------------------------------------------------- DATE------------ DATE �D ----------------------------- REVIEWED BY. = -- ------------- --- �Q BUILDINGPERMIT ISSUED--------------------- ------- -- - ----------------------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations:----------------- --------------------------------------------------------------- ------------------------------------------------------ ' -•-- ----------------------------------- ---------------------------•----- .......-------------------------------- ---------------------------------------------- - ---------------------------------- FINAL INSPEC ON BY:-- .. - _ ----------------- ------------ Date--- / ✓=f ---------------------------- 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 - Revisea 5-57 F.P.CO.