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................ �---� ,l V� APPLICATION FOR SANITATION PERMIT Permit No. . .... .._ _. (Complete in Duplicate) Date Issued - ' 3 Applica�on 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------ Moradp :MnteZ,--_-9 ---hiwax_.xzoth.x__neer--Maradc -Lane____.__.._ Phone------------------------------------ Owner's Name------------------------------------ -5--------- -.c.WS_S? -------=---- ------- Address....----------------------------- C'aZ• ---. Contractor's Name---------- ------- Parrish, IrC. Phone_._9_-.90 -------------- Installation will serve: Residence ❑ Apartment House [ICommercial E] Trailer Court [IMotel Other ❑ Number of living units: -------- Number of bedrooms -------- Number of bats ________ Lot size -------------------••- - ---- ----------------------------- Water Supply: Public system ❑ Community system ❑ Private 6 Depth to Water Table 40-_ ft, x Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe M Hardpan ❑ Previous Application Made: Yes ❑ No a New Construction: Yes ® No ❑ - TYPE OF INSTALLATION AND SPECIFICATIONS: , (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ' Distance from nearest well__ 001----Distance from foundation___--Q_--______-__-.Mat-erial___x0_nc-r-Ct.e---B1kS Septic Tank: ----------------Ca acit _29.09-__Gal No. of compartments_----- _56,56,56s:---Li Liquid depth ------Size . Disposal Field: Distance from nearest well...22j_._.._.Distance from foundation____1Q____-__.Distance to nearest loti�ine_1 •_______.. Number of lines---Ono - }_---- Length of each, line_'_lQQ-----------------Width of trench..o2_ -----------------------�_ I ® Type of filter material.L2��____r'.00kDepth of filter material-_-�_�`t__._-------Total length__-10------------------------------- t r Seepage Pit: Distance to nearest w II__ _350_____..__Distance from foundation -.--------Distance to nearest lot line--�-Q______-_ e'T wt ) Briek_.Size: Diameter 33------ -11 - ----Dept'n---�8 - - t ® Number of pits.-..- e------------Lining material------------------ - Cesspool: Distance from nearest well______________-_Distance from foundation.----.------------- Lining material_ ---------------------------- --- Z ElSize: Diameter------------ ---- ------- ------Depth-------------------------- Liquid - �CapacitytW_-- : . _-----gig . well . _ Distance from nearest well------------------------------ - ----- istance from nearest building---------- Privy: --------------------•----- ❑ Distance to nearest lot line--------------------------------------------- -------------------------------------------------------------------- b aystem to Serve four(4) new cabibns ---------------------------------------- k 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 Coun y ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. Parrish, iT1C. -- ract }--------(Owner and/or Con or) (Signed) }- --- ---------------(Title)------- BrPS• - -- ----- -- ------ ---=-- - --- -- (Plot plan, showing siz.e o- , iota}ion of system in relation wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ------- DATE_------ -� Zf `r_;_-------- ---- APPLICATION ACCEPTED BY----------------------- ---- ......... ---------------------- f�f REVIEWEDBY-------------------------------------------------------------------------------------------------------------------------- DATE--------- ------------ -- •---------------• -------DATE------------------------------------- --------- BUILDINGPERMIT ISSUED-------------'----------•---------- --- ----------------- ----------------------------- - Alterations and/or recommendations------------------------------------------------------------- ----•----------------------- •---- ------------------ -------------------------------------------------------------------------------------------- ----- ------------------ FINAL INSPECTION BY--- ----- - ------ ----------------- Date_.. - -----------•r ' SAN JOAQUIN LOCAL HEALTH DISTRICT { 814 North "C" Street C 130 South American Street 300 West Oak Street 132 Sycamore Street k { Lodi, California Manteca, California Tracy, California Stockton, California ES-9-2M 10-52 Revised W-2100 __