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APPLICATION FOR SANITATION PERMIT Permit No. 13. 1.1______ 1]" (Complete in Duplicate), Date Issued ---------- p licat ___ .-plication 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. Rev, Willie De Peterson JOBADDRESS AND LOCATION------ --------------------- ----------------------------------------------- ------------------------------------------------------------ -------- ---------- 115 so, Minerva Street 3-6589 OwnersName-------------------------------------- --- - -- --•------------------------------------------...------------------------------------------- Phone------------------------------------ Same Address-------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------- Contractor's Name--------------------------- PARR ISH INC ---------------------------- ---------------- Phone----979-60"/----------- - Installation will serve: Residence [4 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __z___ Number of bedrooms __3___ Number of baths __z___ Lot size .___.75-f___x-__100 r------ ------------ Water Supply: Public system [2; Community system ElPrivate ❑ Depth to Water Table _4©_f ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Aclobe:] Hardpan ❑1 Previous Application Made: Yes ❑ No P] New Construction: Yes ❑ No ❑ Supplementary Drainage TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) e Septic Tank: Distance from nearest well_________________Distance from foundation--------------------Material__________________._________________.__._1 C EI.sting No. of compartments--------------------------Size--------------------------------Liquid depth------------------------..Capacity------ k Disposal Field: Distance from nearest well_________________Distance from foundation________.____.___..Distance to nearest lot line______._____., ❑ Number of lines-----------------------------------Length of each line-----------------_-----------.Width of trench-------------------------------- Type of filter material-------------------------Depth of filter material---------------------_Total length____--__---_-_____-_-_--_._____________- NoneZ ' Seepage Pit: Distance to nearest well___________-----------Distance from foundation-�----------------Distance to nearest lot 1• 1___3____.___ ( 41 Number of pits------1-------------Lining materia:_QC---BrUlSize: Diameter__.33______.___.Depth_____2 -------- Cesspool: Distance from` nearest well_________________Distance from foundation---------- Lining material------------------------_----------- ❑ Size: Diameter------------------- ---------- ----- Depth----------------------------------------------------Liquid Capacity- - ------------------------gals" h] ; ! Privy: Distance from nearest well------------_------_-----------------------------Distance from.nearest building----_______---_-------_.______..____.__.„j- ❑ Distance to nearest lot line------------------------- ---------------------------------------------------- -------------------------------- ----------------------------�; Space limited: Remodeling and/or repairing (describe)--- ------ - --------------------------------------------------------------------•---------- -- ••-----------------------= :. --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- r� -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------• •----------------------------------- 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. PARRISH IN C , (Signed)------- - -------------------------------------------------------------------------------------------------------------------------------------------------(OX�r Contractor) By:------------------------------------------------------------------------------------------------------------------------------- --(Title)------E-stkmat.or------- ----------------------- (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-------------------------------------- ------------------- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE--------------------------- ---------------------- ---------- Alterations and/or recommendations--------------- -----------------------------------------------•---------------------.--.--------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ----------------- ----- -------------------- ---------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY------------------------1A*ZvA5---------- Date-- ---- ------- Y)251 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-9-2M 10-52 Revised W-2100