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h APPLICATION FOR SANITATION PERMIT Permit No- -___�m_`- 14 211 (Complete in Duplicate) �l Date Issued ---.._��_1�J Applica+ion 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 tOCATfON_.-..$ _ X10NQ. Bacti Q1Q r. _ Qm ary.________ . --_ gn - T .. Owner's Name-----------------SOP-1 I1010__1MCK!ng---CQ.------A=- ------------` 4,' a en1, -ont_r Phone ---3----931 ----- Address... Ant_13,10TB 1161.-N.0•---Pilgrim--- ------------------------------------------- --------------------------------- .................. Contractor's Name----------------------------------------PARRISH---UC-------•----------------------------••---------------------------- Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---------- Number of bedrooms ------ Number of baths __*--- Lot size _0Yer---3-__r'� .u.:____.�'- L1C}�.-_ Water Supply:-Public:sstem Community system El: � Depth to Water Table - Q_ ft. PldS Terminal Character of soil to a depth of 3 feet: Sand ❑ -Gravel ❑ Sandy Loam ❑ Clay Loam ❑ ay ❑ AdobeXX Hardpan [:1 Previous Application Made: Yes No r pp ❑ ❑ , New Construction:: Yes � 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 weli75_ ---------Distant from foundation---3-_Q----------- i 2 ® No. of compartments- eACh _Size_-- b1$ 6 1 N 11 uid depth.- 11 Ca acit -_ .g _ &�. 6"x 6'1 gg 1Fi p Y Disposal Field: Distance from nearest well_.AS2_*----.'Distance from foundation----IQ'-.-_---.Disance to nearest lot line_-_:----I0. Number of lines y1_--Each-__--------Length.of each line--30t 201 of trench2411---------------------------- 2 Type of filter material-_1 -----Rk-----_Depth of filter material---- ----------------Total length----3.0__----&___2fl___________ Seepage Pit: Distance to nearest w,11-'.9 t_-_..------_Distance from foundation--5-1Distance to nearest lot line_-5�--------- 2 Humber of pits.2----------------- ma#anal_ �"r___P�'lCu3$ize: Diameter---33___...48" Depth-------25_--_'----------------- Cesspool: Distance from nearest well------------------Distance from foundation---.----------------Lining material- ----------------------------------- ❑ Size: Diameter.---------------------------------*'Depth---•------•---------------------------------------_Liquid Capacity---------••---------------•gals. Privy:, Distance from nearest well-------------------------------------------------Distance from nearest building-------.----------------:.__----.------.-. ❑ Distance to nearest lot line ---.---'------------------------------ -- w Remodeling and/or repairing (describe):-------Two-__vrarehOluja4-A----fQr----Trwoking__T_erminal-.&-Fruil�_R�_ro_;ving ----Shade-r_. ..-----The---eyS_t.ea-Qn---the--N_0r h-.bldg---to---ger_ve---1---tollet---and--- sty b�� and ----the--- yet.m.oxo---the----snnth---bldg.__A_o----serve...3---- ---and --------------- # .... rira l, -----------`------------------------------------------------------------------------------------------------=------------------------ ------------------------------------------------ # 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/The San Joaquin Local Health District. I __ PARKSH- ZNC e i e a ( or Contractor) (Signed) -- ------- ------------------------------------------- ---- By:----------------•-•----...... ---- - --- --- -----------{Ti+lel ESt tr atoiO (Plot plan, showing size of,lot, location of system ' elation fo wells,_buildi s, etc:, can be placed on reverse side). E , R DEPARTMENT USE ONLY *' ---------- ---------------------- -- REV EIWEDI BYI--ACCEPTED--BY ---- ------_- -- -----------------------------------------------------:-------------- DATE. --------- -------------- BUILDING ------------- BUILDING PERMIT ISSUED---------------------------------- '---------_- _.-._...-•_•_-_---�-_•.....l....... .. . .---- DATE---------------•----•- 4 Alterations and/or recommendations:--------------- ------=----•----•---•----------------•--•----=---------------•------•--•--------------------------------------------------==---•----------- FINAL INSPECTION BY:"== - -------•---------------- Date..------------------------------`---------- SAN ----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-9-2M Revised W-2100