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APPLICATION FOR SANITATION PERMIT Permit (Complete in Duplicate) Date issued --/�_ /S 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—- 920Pa ----------------- an v -3 �_cinn----(�u ----fin erapoliB---Rda--)--- .- - -- ---- ---T , Owner's Name-------------------------------------------LEoNARD--�- 14ERPUT ------ --------- -- -- ---- - ------ Phone-------------7------------ Address-------------- ----- - Address------------------------------------------------------92Q---Patton---A—Zenwe------------------------------••--------------------------------------------------------------------._.. Contractor's Name-------------•--------------•------.PARRISH-----I-MC------------------------------------------------------------------------ Phone- 6 07 -------------- Installation will serve: ResidenceXX Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:1------ Number of bedrooms -1--- Number of baths ---I— Lot size -----51----k---11-al--------------------------- Wafer 1-al--------------------------- Water Supply: Public system ❑ Community system ❑ Private: ] Depth to Water Table A0-'ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeKIC Hardpan ❑ Previous Application Made: Yes L] No ® New Construction: Yes [X 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 6- Distance from foundation-15.1-----------Material-----CC--Bri-Ck---,------- [3 No. of compartments----2-------------------Size$aQ---L"rF lf!--------Liquid depth.----5211--------------Capacity---800---Ga1 S Disposal Field: Distance from nearest well-7.Q.1------.-Distance from foundation-1 _I----------.Distance to nearest lot line--- -I-----_-- Xx Number of lines-------------1-------------------Length of each line--3-0 I__-----------------Width of trench---24"-----_------_____-•--. Type of filter material1W —Depth of filter material-la- -------------Total length-------3��-__------_----__----_------ Seepage Pit: Distance to nearest well___- --aQ-1------Distance from foundation----20....._._.Distance to nearest lot line------SI.--.-- O -------Linin material_---Q--.5X71 C Number of pits------------�•- 9 - ----.-lZize: Diameter---GG_-�.x'.].-Cbepth....25-1- ------------------ Cesspool: Distance from nearest well-----------------Distance from foundation......-------------.Lining material------------------------------------- r-1 Size: Diameter-------------------------------------Depth------------------------------- --------------Liquid Capacity----------------------------gals. Privy: Distance from.nearest well-------------------------------------------------Distance from nearest building---.-..-_----.----_--___---__-.--.-_-.-. ❑ Distance to nearest }ot line--------------------------------------------------------------------------•--------------------------•----------------------------------------- Remodeling and/or repairing (describe)-------------------------------------- ----------------------- ------------ ---------------•--- ---•---•---r--------------------------.......----------------------------------------------------------------------------------------------------- •------------------------------------------------ I hereby certify that I have prepared this application and that`'the work will be done in accordance with San Joaquin County ordinances, State laws, rules and regulations of t e San a�quin Local Health District. Si ned P S INC .- . .,� ----------- ------------- ------ -- ----- --- { 9 � Contractor) ----- – title Est i latox' By: ------ --- (Title) (Plot plan, showi size of t, cation of system in relat71f 0 w Ils, buildings, etc., can be placed on reverse side). FOR EWPARTMENT USE ONLY APPLICATION ACCEPTED BY- -- --- ---------------------------------------------- ---------------------------------------- DATE -------------- ------------------------------ REVIEWEDBY---------------------- ----- -- -- ------------------------------------------------------------------------------ DATE---��-----------------------•----- ---------------- BUILDING PERMIT ISSUED------------------------------------------------------------------------ --------- ------ DATE--------off--------- Alterations and/or recommendations:------------------------------------------------------------------------•-•---------------------------•------M1------------- ----------------------------------- --------------------------------------------------------------•---•----- -----------------------------------------------------------------------------••-----------------------------••--------------------•---------------- ----• -•---•----------- ------- ------------•----- -•------------------- ------------------- FINAL INSPECTION BY: Il - Date ////;/5-2-, ----------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 30D West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 10-52 Revised W-2100