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APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) <br /> Date Issued .... <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install I t� h rkti rrein described. <br /> This application is made in compliance with County Ordinance No. 549. Wrr 9� 44 <br /> JOB ADDRESS AND LOCATION - -- -...... ­­_.2940Loomis- .. , <br /> Avenue.......--- <br /> .Owner's Name...-------------- -C--.L. <br /> --------Read------------------.........--'-------------------------- -..._............. ---`-- ----`--................. Phone- -- ---------------------•--- <br /> Address ------------ ....... ................... <br /> Parrish Iris - HO 6-9607 <br /> -'----------...---------- --------- --------------..-------------------------------------------------- Phone-------67.9-607....... <br /> Installation will serve: Residence [2F Apartment House Commercial ❑ Trailer Court ❑ Ivjotel ❑ Other ❑ <br /> Number of living units: _--'._ Number of bedrooms... Number of baths ._.1.. Lot size __.__�.._.a.....rB$ <br /> Water Supply: Public system ❑ Community system ❑ Private:E Depth to Water Table _q ft <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe MC Hardpan ❑ <br /> Previous Application Made: Yes ❑ No ® New Construction: Yes ❑ No:] FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well----------_----Distance from foundation-----..-------._._.Material_...........__.......................... <br /> .... <br /> Extgting No. of compartments....................'.....Size.__------------_-_-_..----._Liquid depth_..--..-----------------Capacity........—...-T..... <br /> Disposal Field: Distance from nearest well----50__---Distance from foundation. t20_......Distance to nearest to O <br /> ��]qq Number of lines........._1................. Length of each lina......75.._... Width of trench. t.._.....__..._.......__ <br /> E%3Stirig Type of filter material__.arOC�i.---Depth of filter met erial___...._r g p <br /> Total length ..... -....---- <br /> Seepage Pit: Distance to nearest well...._................Distance from foundation........._:.-._.-.Distance to nearest lot line... <br /> Cl Number of pits----------------------Lining material--------.._-----------Size: Diameter------------------------Dept h..._____.._.__..-.___.._---- � <br /> Cesspool: Distance from nearest well................Distance from foundation__--------._.._.Lining material.--------.--------.... <br /> D <br /> Diameter ameter..................................... e th.................................................... uid Ca cit <br /> ❑ Si - pLi q Pa Y---.-------------------._gas. <br /> Privy: Distance from nearest well........................._._.............._.__..Distance from nearest building.....__.__-._.__..........__.... <br /> ❑ Distance to nearest lot line........................-...............................................................................-........................--------- t <br /> Remodeling and/or repairing (describe):............................ t <br /> ---`-.....................................................---------------------------- ---------------- ----------------------........-....—............................ <br /> '--------- -- -- <br /> -- - ------ ------ <br /> ---- - - ----- --------- - — - - - ....................................... <br /> -- ------...-- ---------------------------------- ------------------------------- --•------ <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> 1 ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> Si ned Parrish In¢ <br /> --------- _.. ..... __........................... Owner and/or Contractor <br /> By:------------------------------Bi11_Wright------------------------------- ----------------------(Title)-----Est...----- <br /> (Plot plan. showing size of lot, location of system in relation to wells, buildings, a+c., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY.-......................... ........... . DATE-------..... <br /> REVIEWED BY.- - ----------- <br /> -- — ......................... - -........ DATE. -�. . ----------•--------- <br /> 14 <br /> BUILDING PERMIT ISSUED------------------------------------- ------........... ---------__- ---—__--------• DATE..................................__.... --•--•----- <br /> Alterations and/or recommendations:---.---.........................................................................__-----------------•--_...—..........._-----------------`-- <br /> ---------.____.-----.........-.......—..........._.------------------------------__...............................................-------.....................-......................._•............. <br /> ----'----------------------------------- ............. ......................................................L '-------_.._...------------------------•--•----_.......-............--------'- <br /> ---------'-------------------'- ---------------------.--------- <br /> - <br /> `-----------`------------ -----.....---------`------ s 1 <br /> FIN AL INSPEC TION BY:. ------------------ -.... Date L_ ---- ------ ..........-........... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 014 North "C•' Street <br /> Stockfon, California Lodi, California Manteca, California Trary, California <br /> ES-9-2M . Revises 1.57 VPCO. <br />