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�_D APPLICATION FOR SANITATION PERMIT Permit (Complete in Duplicate) �. Date Issued ---Y2T1. Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This applicatiori is made in compliance with County Ordinance No, 544. JOB ADDRESS AND LOCATION___________________5238-__East,Lafayette- Street --------------------------------------- ---------------------------------------------- Owner's Name--------------Orvel M. Gaston H0�-16 6 -------------------- - Phone - 1---- ------------ Address-----------------••---------ame-•a s_.-above----- Contractor's Name----- --A � --- Phone HOE7-9607. Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of livingunits: __--Z_ Number of bedrooms 3----. Numbe`r of baths __!___ Lot size __-_�O_Ix100 1 Water Supply: Public system [k Community system ❑ Private^❑ Depth to Water Table 50__ ft. Character of soil to a depth of 3 feet: Sand ❑ Grave! ❑ Sandy Loam ❑ Clay Loam E] Clay El Adobe [2 Hardpan ❑ Previous Application Made: Yes El No E3: 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 Existwig No. of compartments-------------------- ----Size-------------- 4---•-------Liquid depth---------------- Capacity Disposal Field: Distance from nearest well________________Distance from foundation--------------------Distance to nearest lot line_---____.._-___. Exls4ing Number of lines-----------------------------------Length of each line___-'--------------------------Width of,trench---=:_-=----.---------------- Type of filter material-------------------------Depth of filter material--- ---- otal length--------------------------------- Seepage Pit: Distance to nearest well_NOIIQ--------Distance fromkfoundaticn---�-0_I—,I-_- 1jance to nearest} •ne__25_1-____._ ® Number of pits-----OYI[?---------Lining material ...rQC-------�-Size: Diameter•_-✓-'------------Depth___ -""�4--------------------- Cesspool: Distance from _ nearest well----------------- from foundation-------------- material--------- ___-____--_-_____-_ ❑ Size: Diameter------------------------- -----------Death------------------------ g --------- ------�`---------------- Liquid CapacifiY- ------------- - gals. Privy: Distance from nearest well________________________________________-__----- Distance from nearest building ❑ Distance to nearest lot line----------------------------------------------------------- --------------------- Remodeling and/or repairing (describe)-------------- dditional drain owner tIQ CDnnect _t.0 eX�Sting ------• ---I--• - - ---- -------------------------------------------------------------•-------------------- ------------- _.Ayg-t_em---------------- i --------------------------------------------------------- -------=-•--•------------------•------------------ ---------------------------------------------- ----------------------- -------------------------------=------------------ �"� 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. Si ned D.A• Parrish & Sons g )---- ..--------------------------------------------------------------------------------------- [Owner and/or Contractor] BY: ------------ (Title) rSt ' i (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 \IN APPLICATION ACCEPTED BY----- ----------------- ` t' § ) _ , DATE ----------------- ------ ----------------------- EVIEWED BY -)--------------------- ---------------------------- DATE-------------------- BUILDING PERMIT ISSUED----------------------- - -I- _ DATE.--- ----- -------------- ------ ------------------ OV a - - ---------------------• ---------- Alterations and/or recommendations___________ ------------- -----------------------------••-------•------ I ---------------------------- -----------------------------•---------•-•-----•--•------•--------- r ------------------------------------------- ----------- ------- �_ - = v - - ------- --.^- ---- --------------------- ------------- ---- ---------•------ U - ------------ ------------------------------------------ ------------------- FINAL INSPECTION BY.1&6t—?6t-? -_-_- Date-----3~-------c ---/7/ ------ --------------- 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 , Revisea 1.57 F.P.CO.