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APPLICATION FOR SANITATION PERMIT ' 1 a + (Complete in Duplicate) 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. ,y 75/, r— �?,A41--P/ . JOB ADDRESS AND LOCATION--------------Lot-_a„3----Garabald.---Gaar_'den__�F",arm.,___QfJ:'__.Cheery_---�--_R__aad---- Owner's Name---------------------------------Jack---ID._---QS_b.orne------------------------------------------------------------------------ Phone--------5�-51.84..-------- Address---------------------------------------------51?-3--E-•_-.Washingt-ori--St+---------------------------------------------------------------------------------------------------- Contractor's Name-------------------------- ---PAR-RISE---&__E_01iS_t---INC-.------------------------------------------ Phone---------949607--------- Installation will serve: Residence X$ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms (a Number of baths a] Lot size----____bQ1----x_-2-5t'------------------------- Water Supply: Public system ❑ Community system ❑ Private$] Not yet in Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeKK Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) t p Tank: Distance from nearest well-----5Q_-----.Distance from foundation-_---1Q 1__-_-_.Material_--C"C_-_Hr_1ck_____----------------- Septic No. of compartments--------2---------------Capacity--- �e---- X�Ei-_-3L63� iquid depth 521t Cesspool: Distance from nearest welt_________________Distance from oundation____-_-_------:---.Lining material---____--------------------_--__---_. ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------- Privy'. Distance from nearest well-------------------------------------------------Distance from nearest building_---_____-__------_--__.--__--------.__. (] Distance to nearest lot line________________________________________________ 1 Seepage Pit: Distance to nearest well-_----1001-----Distance from foundation_-___-_']G_!-___.Disfance to nearest lot ling__--__a._Q_r__. + [$ Number of pits---------I----------Lining material__C.�r---B�`_iS.tze: Diameter------- tt- ----.Depth-------2.0------------------- ! Disposal Field: Distance from nearest well___-5Q-----.Distance from foundation----201-------Distance to nearest lot line_________________ Number of lines-------1------------------------Length of each line------------501_-- i ---- Width of trench------214t!------------------_- Type of filter material------1*_ -mak-Depth of filter material----------l$____-_ Remodeling and/or repairing (describe)------------------New---ins-tallat-iori----------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- J ----------•-------------------------------------------------------------------------------.------------------------------------------------------------------------------------------------------------.------------------- 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 regula 'ons of the $an Joaquin Local Health District. (Signed)- -n AR T, S 9 3 ZNC.-------------•-------------•---------------.----------------.----------------{�i Contracto') �-- ---- `---------- --- -------------------------------------------------------------(Title)_----F,..S imator--------•------- (Plot plans, shoof lot, location of system i relation to wells, buildings, etc., must be filed with Phis application). f FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------- __- --- -------------------- DATE---- /` r--- - --'-- ,C��--------------- REVIEWEDBY------------------------------------------------------------------------------------------------------------------------------ DATE------------------------------------- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------- Alterations and/or recommendations-------------------------------------------------------------- --------------------------------------------------------------------------------------------- a --------------------------------------------------------------------------------------------•------------------------------------------------ ----------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ----------------------------- ------------- PERMIT No----[__/------------- ISSUED----------------- -- i,1 (Date) FINAL INSPECTION BY:-------- -- ---E __ ---------------------------- Date---------------------------------------1 � SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California E5-9-2M 9-b0 W-1639