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w n Y APPLICATION- FOR SANITATION PERMIT Permit /.g-.,7 (Complete in Duplicate) P ) 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__------- 1307 Meadow Avenue Owner's Name------------- --- ------ -- --- ---- ----------•-- __ Same as above - - --------------------------- - Phone- - - ------- ----------- ---------------------------- Contractor's Name-------------•----PSiSoriS_-------- - ---- ------------------ ------ - --- Phone-Ho6-9607 Installation will serve: Residence � - �- [ Apartment House F] Commercial El Trailer Court 0 Motel ❑ Other [J Number of living units: --1--- Number of bedrooms _--3__ Number of baths --- --_ Lot size ___-_-_- -OOXI�O Water Supply. Publics stem PP Y y ❑ Communit systemDepth Character of soil to a depth of 3 feet: Sand ❑ y Gravel ❑PrrSandy Loam EtClayaLoamfer a❑e1C a ft A Previous Application Made: Yes . Y ❑ dobe ® Hardpan ❑ ❑ No ® New Construction. Yes ❑ No JU FHA/VA: Yes [1 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 welt__--- ------Distance from foundation_____-___ ExislRn No. of compartments------- --------- ------Size__------------ ._.Materiai.--- Disposal Field: Distance from nearest welt__- ---•_-_--- Liquid depth -------------------------Capacity.__------ ---------- -50-� t Distance from foundation... 101 to nearest lot line__.___�j-__„• Number of lines-_____-- EXiS in -- o - Length of each line_-------- Q_-_- - Width of firench._--_---24 it g Type of filter materials---I'Qk Depth of filter material_-___Zg11_-______..Total length___._!------------ ------- Seepage Pit: Distance to nearest well_______ ___ __ ____ Distance from foundation________ ________.Distance to nearest lot line.--______-______ �1 ❑ Number of pits_____ ___ ____________Lining material.__-____--- -- ------..Size: Diameter------------ ------.---.Depth.---- ----•-- -------- ❑ material---..--. -------- O Cesspool: Distance from nearest well______________ Distance from foundation ---------------------_--_ Size: Diameter------ ---•- ----------- ----- ----Depth-- - ----------------------- ___---_-------__-.Lining material- - gals. Privy: Distance from nearest well_ Distance from nearest building-.-----•-Liquid Capacity...--- ❑ Distance to nearest lot line_---__- ---------- Remodeling --_ ___Remodeling and/or repairing (describe);._..___.-_•._-__- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joa-------------- quin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. S� � .gned)--------Parrish--&---S-ons----------------- -------- ------- - wner and/or Contractor) By:— B Wright--- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). --------------------------- •------------(Title)--------��' ------------------------ FOR DEPARTMENT USE ONLY y APPLICATION ACCEPTED BY---------------------------- REVIEWED BY DATE--- BUILDING PERMIT ISSUED ------ ----- DATE.----- --------- ----- DATE.------ - ` Alterations and/or recommendations:_______- _---_ ----------- . --- - ------ -------------- FINAL INSPECTION BY_____________• --- --•----- Date-- --�- ----- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wes+ Oak Street 132 sycamore Street 814 North "G” Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revisea 1-57 F-P.CO.