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FOROFFICE USE: ��f,�-� 0/ ------ -- - - - ------------------- APPLICATION FOR SANITATION PERMIT Permit No.--------------------------------------- ------------------------------------ (Complete in Duplicate) Date Issued __-._____________________..-__ ................ This-_Permit Expires 1 Year From Date Issued 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 CuOrdinance o. 5 .5� >�lif--.� JOB ADDRESS AND LOCATION-------------;4`0.n_T%Q __Aj1__r_L0_Q_r_t'__Wqr---karipec,a.-----------Tex?c-Q__5ta-1Aon----.---.------------------- Owner's Name---------- ------- -------------------------------------------------------------- ------------------------- ------------------ Phone.------------- --------------------- Address----------- ----------- .1QQ2. ----Manteca--------------------------------------------------------------------------------------------------------------------------------- Contractor's Name D.A._-PArrish---- Sons--Inc• ----------------------------------------------------------------------I.. Phone----------------------------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ® Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ________ Number of bedrooms ________ Number of baths __2_-- Lot size ____ACerage Water Supply: Public system ® Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam K] Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan a Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes ❑ 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 foundation--------------------Material-__-___..___....__-_____..___-__________._______- IMST2NG No. of compartments- -------------------Size-•------------- ------Liquid depth--------------- ----------Capacity---------------------- Disposal Field: Distance from nearest well-----------------Distance from foundation_-_____-l4------Distance to nearest lot line------ Number of lines___________---___________ ----------Length of each line______ .Ofl ------_-----Width of trench.........36!! -- Type of filter material----------S/Fi_-----_Depth of filter material------ . ! ---------Total length________10Qz________________________ 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-------.--------------------_-____.__ ❑ Size: Diameter--------------------------------------Depth--------------- ------------------------------------Liquid Capacity---------------------------gals. Privy: Distance from nearest well---------------------------------------_-------__Distance from nearest building.____.-______-_______-_----__-__-___._. ❑ Distance to nearest lot line----------------------------------------------------------------------- -------------------------------------------------------------------- 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 County ordinances, Sta+e laws, and rules and regulations of the San Joaquin Local Health District. (Signed) L..A• F.Arri - - h CA (Owner and/or Contractor) By (title) �`st:Lma ,ar (Plot plan, showing size of lot, location of system in relation to wells, buildings, efc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---_._ . .. ........... .--------------- �� -'.- - DATE----------- ---�--- --- �-�-�----------------- REVIEWEDBY---- - ------------------- -------- -- ----------------------------- -------------------- ----------------------- --------- DATE-------------------------------------- --------------------- BUILDING PERMIT ISSUED---------------------------- -------------------------------- DATE------ ----------------------------------------- G Alterations and/or recommendations----------------------------- ------- ---------------•---------------------------------------- •---------------------------------------------------------------- y --------------------------- ----------------------------------------- -------------------------------------------------------------- ----------------------------------------------------------------------------------- N ------- ---------- - ------ - ---------- ---- ------ - - - -------------- ----------------- ------- --------- - ------------ ---------------- ----------------------------------------------------------- FINAL INSPECTi Date — �-� SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hasellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California