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qi, APPLICATION FOR SANITATION PERMIT Permit No. ------ (Complete in Duplicate) 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 County Ordinance No. 549. JOB ADDRESS AND LOCATION-----A--------------2616__E_,___Washington Street--------------------------------------------•--------------------------------- Owner's Name------------------------------------ ----• ----------- im--Gomez---------------------- ---------------------------------------- Phone----2 =4979--------------•-- Address-------------------------------- ---------S�-------------•---------------- Contractor's Name D' A._PAI�RISH &_ SONS, INC........-.�-" Phone_9-900 Installation will serve: Residence U Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:______ Number of bedrooms __-2__ Number of baths _1____ Lot size ____---r�---t___�Q--__________________________________ f Water Supply: Public systemIKI Community system ❑ Private ❑ Depth to Water Table _49ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adob'AK Hardpan ❑ Previous APP lication Made: Yes ❑ No ❑ New Construction: Yes E] No E] 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__________-____--___---__-__________________-_. E (i13ting No. of compartments--------------------------Size-----•--------------------------Liquid depth--------------------------Capacity----------------------- Disposal Field: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line________________. ExilVing Number of lines-----------------------------------Length of each line------------------------------Width of trench----------------------------------- Typei of filter material-------_-----------------Depth of filter material----------------------- length________________________ __---------- Seepage Pit: Distan I.ce to nearest well---None---------Distance from foundation___I5=__________Distance to nearest lot lineg� _____ ________________. Number of pits___it----------------Lining material_CC'__Bri0k_ Size: Diameter____4�n______-___Depth____25t--------------------- 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---------------------------------------------------------------------------------------------------------------------------------------------- Owner will make own connections... Remodeling and/or repairing (describe):-------- - -- ---------------------------------------------------------------•----•---------------------------•-------- I ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------- ---------------------- ------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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. (Signed)---D-' A. PARRISH & SONS' INC• ` ` .' . ' � [ Contractor) ------------------------- ------------------------------------------------------------------------------------------------------------- (Title)----Estimstor I (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 a APPLICATION ACCEPTED BY------- - ------------------------------------- ------ DATE REVIEWED BY----------------------------------------------------- ---------- -------- DATE-------------------- - - ---------------------------- BUILDINGPERMIT ISSUED-------------- ----------------------------------------------- -------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations:-------------------------------------------------------•------------------------------------------------------------------------------------------------------ --------------------- ------------------------------------------------------ -------------------------------------------------------------------------•----------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ---- --------------- ------------------------------------- ------ ----------------------------------------- ------------------------------------------•------------ l FINAL INSPECTION BY:-------Yj___.___. ,f Date---- --- - -----------vfpl�-------------------------- 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 F ' ES-9-2M 8-51 Revised W-2€00 1<