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APPLICATION FOR SANITATION PERMIT Permit No. __._�•_________________ (Complete in Duplica#e) 7 Date Issued ______11 q'7- 070(- d7 Applica{ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work her rn described. Thi plication is made..in,compliance wit County Ordinance No. 549. on North side of North Ave. � Lat (nth. place east of Hi Way 99 on NORTH AVE. Manteca JOB'ADDRESS AND�LOCATION.------------ ----------------------------------------•-------•---------------••-------------------------------------------- ----------------------------------- Owner's Name-----------Mr. Jack TomlinsonHO 4-5095 -----------•---------------------- -----------------•-------------------------------- Phone----- --- ._....-•-------- Address 2151 E. Myrtle St. Stockton -------- -------- -- ---- ---------------------- ARR Contractor's Name_____________________________PISH Inc. Ho 6--960'f - --•--H Phone----------------------------------- Installation --• - -- Installation will serve: ResidenceXX Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __1___ Number of bedrooms __3--- Number of baths ___l__ Lot size --20 1- X 1 ---- 00------------------------------------- Water Supply: Public system ❑ Community system ❑ Private)a Depth to Water Table _ "-.__. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [; Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ r Previous Application Made: Yes ❑ No N New Construction: Yes ] No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: Septic Taokseptic tank or tancesfrom[ Peare'st delf-p� lit sewe 'available within'200 feet.] 010 CC Brick p Distance from foundation--------------- -.M eiial-------------- ------------- ------- dIA No. of compartments-------Z--------- 6�X tex 800 {------ Size Liquid depth Capacity - --- - ---- -------- Disposal Field: Distance from nearest wefi_��_t........Dist...e�from foundati�j i�_ _______.Distance to nearest IaLline___ _�_______- Number of lines__2______ _ Length of each line-------1_-�------------------Width of trench-_-___ _ Type of filter material I2 ..��_______Depth of filter material-____ 15-0-Y---------------------- Type length________�Sa _____________________ -- Seepage Pit: Distance to nearest well____________ ____- Distance from foundation----.....__.....----Distance to nearest lot line----------_._____ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter------------------------Depth----__------_-------------------. { Cesspool: Distance from nearest well-----------------Distance from`foundation____----------------Lining material-------------------------------------- 1771 Size: DiaTneter------------ -------------------------Depth---------------------=------------ -- --------------Liquid Capacity----------------------------gals. Privy: Distance from .nearest well-------------------------------------------------Distance from nearest building------------------------------------------ r_1 Distance to nearest lot line-------------------------------------------------------------------------------------------------------------- - Specifications approved for a 3 bedroom house r Remodeling and/or repairing (describe)-------- ------ -- a -----------------i -- -- - ------------------------------•----------•- •-------- on PHA sale of said house. -----------------------------------------------------------•--------------•-•--------------------------------------- -----------------------•-------------------------------------------------------------- - -� -------------------_----------------------------------=--------=-----•---•--------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application anden k will be done in accordance with San Joaquin County ordinances, State laws, and rules and reg ns of the San JHealth District. PARR. INC e ------.---(0 � Contractor) (Signed) ------------ - - Estimator .. gY: = ---------------- -------- ---------- ---------(Title)-------------------•-••---•------------------------------------ 11 (Plot plan, showing size of lot, Iota . n of stem in relation to wells, uildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------------------- I - ---------------------------------------------------- DATE-----------1� ------------------ REVIEWED BY------------------------------- - ---------------------- DATE----------- l /----- --�---------- -- ---------------------- -- ------------------------------------------ - ------------ BUILDINGPERMIT ISSUED----------------- -------------- ----------------------- DATE--------------------------------------- Alterations and/or recommendations-------- ------------------------- -------------------------------------------------------....._-----•-_---- ------------•--•-------------------- -----------------------------------------=--------------------------------------------------------------------------•--------------------•---•-•--•-•---------------------•-•---------------------------------------------- -•------------------------•--•-----------------------------•----------------- -------•-----------•------- Y----- FINAL INSPECTION BY:. -------------------- Date------. �'�--� -------------------------------- 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--21v1 Revised W-2100