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A}' APPLICATION FOR SANITATION PERMIT Permit No. .�lS (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--------628------ Gratton Straet ---------- Owner's Name-------------E----- tZgEraII----------------------------------------------------------------------------------------- -------- Phone--HO--2-p393-----•- Address--------•---------------�?2$ --Gr.-a t Von Pa rr i sh & S one - ------ Contractor's Name------------ -------------------- --•--------------- Phone.._-HO 6"9607 ---------------------- ---------- ❑ ❑ Other ❑ ------------------------------- Installa}ion will serve: Residence JK] Apartment House ❑ Commercial ❑ Trailer Court Motel Number of living units: ---!-- Number of bedrooms ---3-- Number of baths -1---- Lot size -_----7,5400 Water Supply: Public system ® Community system ❑ Private ❑ Depth to Water Table ---410 Tt- Character of soil to a depth of 3 feet: Sand ❑ Gravel [] Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ® Hardpan ❑ Previous Application Made: Yes ❑ No [2 New Construction: Yes ❑ No %] 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--------------------Material --_.-_-------_.---------- existing No. of compartments--------------------------Size---------------•------------: -----___-----.___----. ---Liquid depth----------- CepacitY Disposal Field: Distance from nearest well--NQrl!!_._Distance from foundation-----JC)!..---.Distance to nearest lot le-------�5'-- � Number of lines------------IS---R------------Length of each line-------30_---------------width of trench-------21+11 ----•--------•-- Type of filter material-------------0.4 ___Depth of filter material_--�a_.------------ length-----------30--------__----_- Seepage Pit: Distance to nearest well------01149----Distance from foundation-____ ..0'_____.33 ince to nearest lot line_----5�------- ® Number of pits__-.--_Z-------__---Lining material---Y'©C_ ._-.---Size: Diameter-_-- -- ----.Depth------- 2-7rt - -----•---------- 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):---------- --------------------------------------------------------------- -----------------•---------------------------------------------•---------------------------------------------------------------- --------------------------------------I------------------------------------------------------ I hereby certify that I have prepared this application and }hat 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) Parrish & Sorns - - - - - - --- --- ---- - ---------------------------------------------------------- ------------------- -------------------------)Owner and/or Contractor) BY---------------------B ill__Aright-------- -------------------(Title)-------E"--I-t-------•---------------------------------------- (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------ - -- -- - � ------------ ----------- -•-----•------•------------ UILDING PERMIT ISSUED ------------- ---------------------------- ------- DATE Aiterafio s an orscam endations:_----------------------- -----,_----___-- ...... t „----------------------------------- ----- s FINAL INSPECTION BY----- - E i'L ----------•---------------- Date—-------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 914 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES---9-2M , Revised 1.57 F.P.CO.