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APPLICATION FOR SANITATION PERMIT Permit No. _./I.. 4. . (Complete in Duplicate) Date Issued ...... ..3 ..".._�... Application is hereby made to the San Joaquin Local Health District for a permit to construct and install� e w k`Grein described. This application is made in compliance with County Ordinance No. 549. W� 2940 Loomis Avenue � JOB ADDRESS AND LOCATION----------- -- ---- --- ----- -- -- -- ---- - ----- -- --- Owner's Name.................C- -. L�---.-Read• ------------- ..... Phone---••----•-----•----•----._'...... Address Same as above ...........................•-- ....•-----....................................................................................................................................... Contractor's Name.........ParriSh InC HO 6-9.607 . . ... Phone. .-•---- Insfallation will serve: Residence [2F Apartment HouseCommercial E] Trailer Court ❑ hotel ❑ Other ❑ Number of living units: - 1 Number of bedrooms Number of baths ...... . Lot size - __---_. 8Cre8 Water Supply: Public sysfem ❑ Community system ❑ Private-E Depth to Water Table .40.tft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe PgK Hardpan ❑ Previous Application Made: Yes ❑ No R1 New Construction: Yes ❑ No 7L 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 we! - . .Distance from foundation.. .... ... ....... Material............... ................. .......... Exlot ing No. of compartments............... ..........Size---.---_---.....-.-:---.........Liquid depth.---------------_--------Capacity....................... Disposal Fie`d: Distance from nearest well 5d .D'starce from =oundafion. .t.20._..____.Distance to nearest lo�4M...50 ��qq Number of lines_._......_1.......... .... ......Length of each line._.__ 7.51... .. Width of french. ''�F Ex3stin s rock 10""'Total �.. ............. ...... Type o. filter material............ ........Dept of filter metenal Tota! leng+h.. .__.__. Seepage Pit: Distance io nearest well......................Distance from foundation....................Distance to nearest lot line......._........ ❑ Number of pits......................L;nrg material.-. Size: Diameter------------ ..... Depth_.... . .... ... . ............. Cesspool. Distance fro-n nearest well.. ............. Distance from founds;-ion ........ Lining material . ...._. .......................... ❑ Size: Diameter-------•..............................Depth.....---•--........--------•-••-----------......•--.Liquid Capacity..- --------------- - ----gals. Privy: Dislance from nearest well..... ............_...........................Distance from nearest building.. ...................... ❑ Distance to nearest lot line............................... .......... ........... ... ......... ................ ...................................................... Remodeling and/or repairing (describe):............... .................._t...----------------•-•................. --- ---------------- -----------•----=•------- ----•......•••-•....-•-•-------------------------------•-------------••----.-•••---••-••-•--•-----------......._---•••--••••--•-----...............---.....---...........-•-------•--•------------...... ....... .. ......... --------------•---------------------------•--------- -------------------------------------—......................................................................................................................... ........ 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. (Signed) ParrishInGt ------------------------ Owner and/or Contractor Bill---Wri-ght- ------ -------------- ----------(Title)-.....Est-•-•--. --------- ...................... BY�---------------------------------- - - - - - - -- ------------------- (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 -� APPLICATION ACCEPTED BY--------------_---- DATE----------- - REVIEWED BY..------. ------------------------- DATE_......_.��. yl- -------•-•-....•---••..._.....-••....... . BUILDING PERMIT ISSUED............................. ....... .-_--.---- .............................. DATE---- •-•-• -......------••................---•-----•------ Alterationsand/or recommendations:.........................................................................•--......................------.......................----••-------••--.......--.... . ................................ . . . .... ........... ....... .. ...._:_......... ......:................................... ................................................. ------------------ ......................................................................................................................................................................................................... ............................................................. .... ...:........................................................ ................... .......... -- --------------------------------- --------I----------- •--• ---•------------------------------------------- ------------ ----- ------ ---------------------------•---•.........---•-----•.....------.........................._-------•------•••.... ...... .-- -------------------................... qkll� FINAL INSPECTION BY:. ... ... ------ Date------------- f 1 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-4-2M Revisoa 1•57 F?.CO.