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S9 APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued Applic&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. KIO Ave. 3rd house: on right 'of Hi Way JOB ADDRESS AND LOCATION_ Rt. 1---Box 1$ 2_f___LathrOP_.----------------------Y�--� --------------------------------------------------- Owner's [q(�? a -� - - k Owner's Name---•----- 1S. Patista HO $4 -- Phone---------• --------- -------------- ,f. .- 1 same _ Address----------------- ------=--------------------------------------------------•--•----------------•--•------------------------------------------------------------------ - Contractor's;Name_.:__is........................PARRISH INC . Ho 69607 ----------------------------- Phone -•---------- Installation will serve: €Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ +. Number of living units a Number of bedrooms ----2- Number of baths __1__- Lot size -------3&__Acre. Water Supply: Public system'❑ Community system ❑ Frivate'[N Depth to Water Table -------- ft. . Character of soil to a depth'of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [4 . Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑t No [7, New Construction:-Yes'❑ No IM Drainage 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--------------------1 --Size----•---------------,-------Liquid depth-------------------------Capacity------------i---------- Di�posal Field: Distance from nearet we!I__ -- ------ Distance from foundati n__r___20____..__Distance to nearest Iq�t line---- (� Number of lines____________ Length of each line___�10________:___--__.Width of trench__24______._________________ "1 19"---Ric W Type of filter material_____2_________-_______Depth of filter material-_-------18��------Total length---5Q_t___ ' --------------------------- � C Seepage Pit: "Distance to nearest well----------------------Distance from #oundation-.....:.__i.._._...Distance to nearest lot line__________._____ ❑ Number of'pits----------------------Lining material---------- ------Size: Diameter-----------------------Depth-#-----------------.-:---------- Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material___.__-.___._______._______--_- ❑ Size: Diameter----- - •-------- -------- -----------Depth----------- '-----------------,---------------------Liquid Capacity---------------•-------------gals. Privy:: I Distance,from'nearest-well_._ ___.___s___.___________________.__i___.__._Distance from nearest building_______.____________--_________-_______.'."_ ❑ F —Distance to nearest lot line--------- --------- _. a Remodeling and/or repairing (describe):-------------------------------------------------- -------�------------------------,--___,._,_-..--------------------------------------------------� 1. -------- --------------------------------------------------- ---------------- ----------------------- I -------------------------•-------•-- -•------... ----------- ------------•-•------------ 1 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 f the San Joaquin Local Health District. - PARR TSH ' INC .� t Contractor 4 - ---Si nod)- -- -------•- BY: -------------------------------------- - •----------- ------------------ �---- -----------------;-------------------- LTitle) ---------=- — ------------ (Plot plan, showing size of lot, location of sys m in relation to wells, uildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ - - DATE -------------------•-----------------_-__-- REVIEWEDBY------------•---------------- ------------------------ -'=-------------------------=-----------•----- DATE • a�tt BUILDING PERMIT ISSUED------------ •--------------- DATE----- '� = Alterations and/or recommendations------------•------------ ----------------------------------------------------------••-•-----•-••--------------------------- r --••-•---------------------------------------------------------------------- ----------- ---------------------------•--------•-----=----------------------------------------- ---------------- ----- ----•----- ---------------------------------------------------------------------------- M FINAL INSPECTION BY:_ _-"- - ----------- Date--------=-----=-`-- `^F 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 Revised W-2100