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APPLICATION FOR SANITATION PERMIT Permit No. -- (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 ejrc ,ririJ This application is made in compliance with County Ordinance No. 549. A. West side of Hi Way 991 11auth ofl JOB ADDRESS AND LOCATION_--. Rte 2 Boge 299 - Aaa�npo: 51 Miles north of Lodi on Hik Q ----------------•---- ---------------------• - 9 Owner's Name-------------------Mary n H Adams Lodi 9 �©37 - ----•---------- ------- --------- -----•--- Phone L d Address-----------------•--- lie --------- -- ------- -- ------- ------- PARRISH ,INC, Contractor's Name -------•- ------- Phone-----o--""-9607- • ------------- -------------- -------------------------------------------------------- Installation will serve: Residence Q�X Apartment House ElCommercial ❑ ❑Trailer Court Moteer l ❑ OthEl of living units: ------ Number of bedrooms _2___. Number of baths --1-._ Lot size ater Supply: Public system ❑ Community system ❑ Private a Depth to Water Table ---Gott Plus Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ] Hardpan [XX Previous Application Made: Yes ❑ No [C New Construction: Yes [Q No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) { Dis Septic Tank: No. of compartments -- q p ------Capacity-----8 }4 Disposal Field: Distance from nearest well__- _-Distance from foundation----_----___.------Distance to nearest lot line--__---.-__-- ❑ Number of lines-------------------------------- --Length of each line------------------------------Width of french 7 of filter material-----------------------_Depth of filter material---.---_-____-_----___Total length--------.----•._------------_------------ Seepage ----_ _Seepage Pit: Distance to nearest well--90 t__--_-_--Distanc from foundation---l0_ ......-.Disfi�nce to nearest lot 1. 101 1 - C Briop 25 or �----- ® Dumber of pits----------------------Lining material---------------------Size: Diameter----.,3,3 -.---_............Depth th------------------r___- Cesspool: Distance from nearest well-----------------Distance from foundation,-------------------Lining material-------------------------------------- .-Size: Diameter----------- ---D.epth_------------ryL'Guid Capacity gals. --- ---• --- Privy: Distance from nearest welt.---_----- .--_____-- -- -------------- ---------------- ---------- Distance from nearest building __ nn ❑ Distance to nearest lot line-------------------------------------------------•-------_ Remod lin nd/or repairing (describe):----H---rdpan area. . , leaching drains have proven to be a 91 eranae in this area. ------------------------------------------------ t -------•----------------------------------•----------- ------------ -------------------------------•---------------------------------------• ---------------------------• ------------------------------------------------------------------------------------------------------VA . ------------------------------------------------1----------------------------------------------------•--------------------------•---------------------• --------------•------------------------------------------------- * I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County y ordinances, State,laws, and rules and regulations of the San Joaquin Local Health District. (Signed)--- PARR ISH INC. -----------•--------------------------------------------------------R�� Contrac or �` f By--------------- Title Estimator ------------------•----------- -- -- (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 ' APPLICATION ACCEPTED Y DATE--I ------------------- -------------- -- --------------------------------------- REVIEWED BY--- -------------- ----------------------------------- Y -- --`--- -------------------------- ---------------------------------------------- DATE----- BUILDING PER ISSUED----------------- ------ - -- -- ---- -------------•-- DATE------------ Alterations and/or recommendations:-__ _ ------------ ------------------•-------•----------•----- --------------------------- - ----- -----•-•--------------------------------------•---- ---------------------------------------- -------------- n..- -'--------- ------`c----- .------•--'-- ------ ------- --------------•---------------' --------------•------•------- FINAL INSPECTION SY ------•-- --------------------- ------------------- Date-. SAN JOAQUIN LOCAL HEALTH DIST la f30 South American 5tree't 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