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414 X�t) APPLICATION FOR SANITATION PERMIT Permit No. ._��.!_..__ d (Complete in Duplicate) Date issued ---_______________ _ Applica*ion 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--------•--4331---Homer Street--------------- --- Owner's Name--------------------• Calllpbell--------------------------------------------------------------------------------------- Phone-------------------------------•---- Address----------------------------------5_aIAQ__.0LS---a -Q-Ve-------•----------------------•--------------------------•-•-------------------------•--•------- -----------•-•-•-••-----------------... Contractor's Name--------------D,_kq---Parrish--&.-Sons---enc._-------------_ _.-.-------.--. Phone-HO___6-- 6�7------- ------------------------- -- Installation will serve: Residence [j Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___3- Number of bedrooms _2_--- Number of baths ---1__ Lot size -----3-161---X__141------------------------ Water Supply: Public system ❑ Community system ❑ Private [2 Depth to Water Table _50- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Kj Hardpan [j , Previous Application Made: Yes E] No %] New Construction: Yes ❑ No [X 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------------.__-_____________----__-_.___-_____. EasingNo. of compartments--------------- ----------Size------•-------------------------Liquid depth---------- ---------------Capacity------— ------------- Disposal Field: Distance from nearest well-------5D-t.-Distance from foundation----20..........Distance to nearest lo4�ne---1Q!------ ® Number of lines----------Qne----------------Length of each line-----3j-t-----------------Width of french------_________-------------------- ,1 � Type of filter material__$......RQCk_-Depth of filter material----1$-------------Total length----------3._.t__________________.-..__.. I' Seepage Pit: Distance to nearest well__8O_1------------Distance from foundation___--__- Distance to nearest lot line---1Q-1_____- ® Number of pifs-----on-e--------Lining material_rfiiok..__.__Size: Diameter--------_ 2-5-- °U411------Depth----------2-5-t--------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material--__.-----,_______.________-________ ❑ Size: Diameter--------------------------------------Depth------------------_---------------------------------Liquid Capacity----------------------------gals. ms's Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ (� ❑ Distance to nearest lot line--------..------------ ---------------------------• --------------------------------------- ------------------------------------------------- 'N, Remodelingand/or repairing Idescribe):---------------------- ---------------------------•---•-----------------------------------------------------------------••-•--------------------...._.-. - --------------------------------------•-----•---••----------•--------------------------------------------------------------------------------------------- I hereby certify that l 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)_.......D. A• Parr i Sh &---S-ons ons Inc------------------------------------------------------------------- -------(Owner and/or Contractor) ----- -- -- ------- -- -------- --- -- - BILL WRIGHT__ (Title)_-EST e 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 APPLICATIONACCEPTED BY----------------------------- ---- ---------------------------------------------------------- DATE--- --1-...--------------------------------------------- REVIEWEDBY-------------------------------------------------------- ------------------------=--------------------------------------__ DATE-------- ------ ------•------------------------------------ BUILDINGPERMIT ISSUED---------------------------------�-------------------- ----------•---------------------------- DATE_.�----- - Alterations or recommendations:----------------- ---- -- -----•--------------------••-------- -- -- ------------------------------ -z 'r ---------- - ------ FINAL INSPECTION BY:._�----J---------------•---------------- Date.......ca I- ----------------•--•-------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Sfreet Stockton, California Lodi, California Manteca, California Tracy, California E5-9-2M Revised W-2100