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wl)k �7 APPLICATION FOR SANITATION PERMIT Permit No. ..3 6✓ (Complete in Duplicate) /� Date Issued ___. -t Al 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... ----� - - -- -- ------------------- Owner's Name------------ ------------------- X� 'i$�X--Me1 a13 C�Y'e-Er Phone 2�-2159 ---------- Address---------------------- - 2 E• 'rlet Contractor's Name------------------------------ PARR�-o'�--H- INC INC,----- -- Phone 9-9607 s Installation will serve: Residence)]} Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:)..------ Number of bedrooms------. Number of baths ,----- Lot size :_-5 !x1-00.:__ ---------------------------------- Water Supply: Public system IN Community system ❑ Private ❑ Depth to Water Table _40_ ft. I Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe& Hardpan ❑ Previous Application Made: Yes ❑ No XX New Construction: Yes ❑ No ❑ Replacement TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.)' ; Septic Tank: Distance from nearesr wellN?rid-----Distance' from founclation.l51'_-------Material--------Cr----Ci---Bri.Ck_______________ MC No. of compartments------- ----------------Sizeg.6_iiX�_6!'.1D__-_*Liquid depth----- 2.11--.-_-______Capacityg - ---G l . deep-Disposal Field: Distance from nearest weIINo-- - --.-.Distance from foundation----25--------.Distance to nearest lot line-- i fl i.----_- mc Number of lines---.-- ----_--- Length of each line_'__ a---1--------------Width of trench--- T rench-- Type of filter material----- -1_«__R'k. Depth of filter material 811 ------Total length------3T------------------ ------ Seepage Pit: Distance to nearest welTk4f-t -----------Distance from foundation---A0...........Distance.to nearest lot line--5-1----_----- Dumber of its__I---- materialC_�".r---�r'i-O Size: Diameter___-- 1 p i g Depth--- --------------------- C`1 Cesspool: Distance from nearest well-----------------Distance from foundation----::_----.------- Lining material------------------------------ ----- -►� ❑ . _;..�. +'Size: Diameter._:: = Dept h: .� -- ------------ Liquid Capacity-.----------------------- --gals. Privy: Distance from nearest well.---__-__------- ------------------------------Distance ,from nearest buildingrR El Distance to nearest lot line r 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 Joaquin County ordinances, State laws, and rules and}regulations of +he San Joaquin Local Health District. PART aH.- �1T _:t (Signed) -*---------------- I ( Contract By:------------------- �-` _�_" r"--------------•------ --------------------------------------------------------------`:---(Title)----EB im to-z' or. . (Plot Ian, showin siz r p gf lot, Inca+ion of sysfem in relation to wells, buildings, etc., can 6e placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY__ DAT --- --------------------------------- REVIEWEDBY. ----------------------------------= -------------------------- ------ DATE--- --------------------••------------•-------------- BUILDING PERMIT ISSUED-------------------------------------=- ==--------------- --=--. DATE.-------- Alterations and/or recommendations:-=�-----------------------------------------------•--•--------••-- .••---- ------... ---•--••- ------------- -------------------••-•---------•-------------------------- ----------------------------------------------------- ---------------- -------------------------------------------------------------------I- ------------------•--------------------------------•--------------- ------------ --------•-------------------------------------------------------------------- FINAL INSPECTION BY:----- ,. f —F---------- Dafie / ?, ?��Z._ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 4 300 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