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r FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT �S �� - ------------------ (Complete in Triplicate) Permit No. --- ___ __________ This Permit Expires 1 Year From Date Issued Date Issued _4 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 and existing Rules and Regulations. JOB ADDRESS/LOCATION ._.1;581--_Sixth St.__________________Lathrop_ ---------------CENSUS TRACT -------------------------- Owner's Name ---------------------Rev.--3teph_en__Point� l ---------------------------------------------- -------Phone 982«492 Address --------------------------------Same------------------------------------------------- -----------. City --------lathrop---------------------------------------------------- Contractor's Name --_A.---A-•-__P_A SH__Pk_SANS-s---Ih1C----------------------------License # ---------,-------------- Phone __466!-960---------- Installation will serve: Residence)M Apartment House,❑ Commercial ❑Trailer Court !❑ Motel ❑Other -------------------------------------- ---- Number of living units:.__,1------ Number of bedrooms ___ ______Garbage Grinder ------------ Lot Size _ 0?�120�__________________________ Water Supply. Public System and name -------------- --- Lathro Cammunit- _________________________ __________Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam W Clay Loam ❑ Hardpan ❑ Adobe'❑ Fill Material ------------ If yes,type __________________________ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT ( ] SEPTIC TANK:[ JCX Size---5t-4 ;------.---------------------------- Liquid Depth -------5}.i_.............. -- _t - Capacity 1200---------- TYPePt!e,7Gasii---- Material Conex'-e_te___-• No. Compartments ----:��------------ Distance to nearest: Well .50Q_ydP-------------------Foundation 10_t--------------- Prop. Line LEACHING LINE [ ] No. of Lines _____2_________________ Length of each line____ p ----------- __:__ Total Length _ qr_.___.___________ 'D' Box ;_--------- Type Filter Material$PPUP__k-Depth Filter Material __________ _______________________� Filter Bed Distance to nearest: Well -_540-'X0------- Foundation ._20f_....._________ Property Line _______ _T__ - -----•--- Depth _-_.41 Diameter t_xg+________ Number -----2---------------------- Rock Filled Yes MK No C1 Water Table Depth ~--------Rock Size ___ate-xJ/4-------------- Distance to nearest. Well ------549_Yd,9-------------------Foundation --- ------ Prop. Line -----ST_______.__... i REPAIR/ADDITION(Prev. Sanitation Permit# ____________________________________________ Dbte ___!_________--,_.-______________J S SepticTank (Specify Requirements) --------f---------•----- ----------------------1-1/--------------------------------------:------------------- --------------------------- Disposal Field (Specify Requirements) ________________________ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•-------- --------------- - (Draw existing and required addition on reverse side) 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. Home owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed D. A._ Parrish & Sons, TO-'---------------------------- fir BY -------------------------------- --- ----- Title __F: tar!atgx' - ---- -- ------ ---------- ------ -- - ------------------------ (If other than o er) FOR PARTMENT USE ONLY APPLICATION ACCEPTED BY ---- ---- -------------------------------------------------------------- ----- DATE ------ - ---4715--------- BUILDING PERMIT ISSUED ----------------------------------- DATE ------------------------ -- ADDITIONAL COMMENTS --- - - -- -------------------------••------------------------------------------------------------------- --------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------- ------------------- ---- ------- -- ---------------------------------------------------- ------------------------------- --------------------------- -----------------------------•---- --------------------------------- --- - --- ------------------------------------------------------------ ' ------------------------------------------- _ Final Inspection by: __-- --------------------------Date -------- __?6 -------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M fill✓