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-� FOR FFICE USE: --------------- ---- -------- APPLICATION FOR SANITATION PERMIT Permit No. ...47... - - ----------------- ------------ ------------ pate Issued ._.._...------------ (Complete in Duplicate) � --/�°- _... - ------ --- ---------------------------------------_- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health Distfict for a permit to construct and install the work herein described. This application is made in compliance with Counfy.Ordinance No. 549. JOBADDRESS AND LOCATION------------ Ger#rude..St.-----•---- -------------------------------------------------------- ----------------- ------ Maria L. Phillips----------------------------------------- ---- --------- Phone------------------------------------ Owner's Name--------------------------- ---- Address------- ----- g .- - ------------------------------------------------------------------------ ---��-�..E.�..Wash�n ton-------'----•-------------------•-------------------- - Contractor s Name---------------Parrish---TIhC.------------------------------------- ------- - -------------- - --------------- -- ---- Phone----------------------------------- Installation will serve: Residence ❑ Apartment House [2 Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -�..__- Number of bedrooms -4..... Number of baths __4... Lot size ----------75'..X--125' - 4 Water Supply: Public system 9] Community system ❑ Privatew❑'ryDepth to Water Table __60' ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam E2 Clay ❑ Adobe ❑ Hardpan ❑ I Previous Application Made: (if yes,date-. _.------------- .1 No IF New Construction: Yes ❑ No 13 FHA/VA: Yes ❑ No 29 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) f Septic Tank: Distance from nearest well-----------------Distance from foundation-------------------Material.....---........__.------------.-------..__----. ❑ No. of compartments------ -------------------Size--------------------------------Liquid depth------------------------..Capacity----------------------- Disposal Field: Distance from nearest well---.-------------Distance from foundation....................Distance to nearest lot line.-...__--------- k ❑ Number of lines----------------------------------Length of each line------------------------------Width of trench----------- .-------- ----------- \ Type of filter material-------------------------Depth of filter material-----------------------Total length--- -7 1 Seepage Pit: Distance to nearest well-....g--------------Distance from foundation.-_---10-.-------Distance to nearest lot line....]Qk...... Number of pits-------3-------------Lining material------;'VROck--Size: Diameter-------480---------Depth_---....251----------------- Cesspool: Distance from nearest walla__ _.Distaneeffrom, foundstion___________________lining material.-..... ` 0Size: Diameter------- .Depth -..Liquid Capacity---------------------------gals, Q ti Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_____..._._. ❑ Distance to nearest lot line------------------------------------- ---------- -------•------------------------------------------------------- - ----------------- Remodeling and/or repairing (describe)------------------- ------ tio.- .,.1X1 2t1II-------------------•-------------------------------•--------------- -------- ( ----------•--------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------- j --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------- ------------------------------=------------------------------------------------------------------------------------------ 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, and rules and regulations of the San Joaquin Local Health District. r 5i ned Parrish InC° -- (Owper and/or Contractor) �C • (/ - ----- -------------- (Title)----- _ __ Ry:-------- ------------- --------------- _ (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 r APPLICATION ACCEPTED BY --------------------- ------------------------------------------- DATE ��f. REVIEWEDBY----- ----------------------------- ----------------------------------- DATE------------•----------------------------------------------- BUILDINGPERMIT ISSUED='------------------- --------------- DATE--------------------------------------------------------- Alterat' ns "d/or recommend - ------ ---- -i - - tions-, --A1" - - -------- --------------------------------------------- - ---------------------'----------------------•-------- ---------------------------------------------------------------------•---------- ----:- ------------------------•--- I ------------ ------------------------------------------------------- - ---------------------------------------------------- -- ---------- - ------------ --------- ----- -- DD ------- -------------------- Date. �./5............ - ---------------------------------- SAN -------------------------'------ FINAL INSPECTION BY:.----------�i:---------------- { . SAN JOAQUIN LOCAL HEALTH DISTRICT i 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street } Stockton,California Lodi,California Manteca,California Tracy,California F.P.CC. k