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APPLICATION FOR SANITATION PERMIT f Permit No. ------ (Complete in Duplicated -911 � / c� Date Issued -----------l.._�-{_ 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...........2445_North Wilson Way - ---------------- Owner's Name------- Connell- QtQP3 COtripany ------------- -------------------------------- ------ Phone--------------------------- --- Address_______________________ ___ 1_.1_ NOz'th-_W----- Way -------- ------------------------------------------------------------------ -- --•-- - Parrish & Sons - ---------------- Contractor's Name_______________•__________-- H0679607 Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ TretCQite� Motel El Other Number of living units: -----— Number of bedrooms -------- Number of baths ________ Lot size WaferSupply: Public system ❑ Community system ❑ Private ® Depth to Water Table �ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay El Adobes] Hardpan ❑ Previous Application Made: Yes E] No [* New Construction: Yes E] No ® FHA/VA: 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 well-----------------Distance from foundat on____________________Material___-__.____.-----..___--_-----_ Exiting No. of compartments Size ---------------- -------------Liquid depth----------------------- Capacity------ ---------------- Disposal Field: Distance from nearest well------------50bistance from foundation _ Q-�_--------Distance to nearest lot line_-_-___. �-_•- ® Number of lines---------1------------- ---------Length of each line----- _ _ ._ is Width of trench____0�I--___------ Type of filter material-� Rock g - � --- -------- __Depth of filter mafierial------1$ir--__ Total length--_------�OQ� eepage Pit: Distance to nearest well----------------------Distance from foundation-----.-------------.Distance to nearest lot line______.-.-______ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth---------------- Cesspool: -_________- .esspool: Distance from nearest well-----------------Distance from foundation._.-----------------Lining material_____-_.______'-___ ------ - El Size: Diameter--------------------------------------Depth--------------------------------- ------ - --------Liquid Capacity---------------------------gals.. Privy: Distance from nearest well Distance from nearest buildin � Elg--- Distance to nearest lot line-__----__---- ----._ ----- -------------------------------- -\ ---------------------------------------------------- ------------ ------------------------------------- Remodeling ------------------- - ________Remodeling and/or re airing (describe):----A-d(�___dr lh-n to- eX1Stin S S$@191 fpT OffiC�4--at ----------house..trader sales y -------yard---- - - --------------- 1 ------------------------- ---------------------------------------------------------------•-------------------------------------------------------------------------------- -•------------------- ------ - ----- -- I hereby certify that I have prepared this application and that the work will be done in accordance with--San--Joaqu- -------in Co r ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)--------------- r_'-:Lsj._..&...SQ12S {Owner and/or Contra ------------------------------------------------------------------ �y -------------•---------Bill Wright---------- ----- Est - - {Title)------ ---•-------- -- -- -- (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 BY----�i_R_$D---�---------- �---------------------------------•------ •-----------•---- DATE--- �-�7 REVIEWEDBY--------•-------------------------------------------------------- - --------------------------- ------------------- DATE------------------------- UILDING PERMIT ISSUED----------- ------------- -------- - ---------•---------------------- - --------------------------------- DATE----------- --------------•------------ ---------••----------- Alterations and/off recommendations:_____-.:_.______________________ ------------------------------------------ ---------------------------------------------•---------•----------- -------------------------- FINAL INSPEC ------- - ----- Date-------_✓ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Sfree+ 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES---9-2M Revisea 1-57 FY.CO.