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= FOR OFFICE USE: 3 �G 6 �_Q- APPLICATION FOR SANITATION PERMIT Permit No. .___ ___-_-._.__ ------------------ ---- -- (Complete in Duplicate) ��7// (o r __ ___._._ This Permit Expires 1 Year From Date Issued 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-------------2.12__Indultra.al__prime-------------------- ------------------------- ------------------------------------------------------- Owner's Name---------------__IJ_°7d__Pspas---Construe__ti0XL._.c-•------------------ --- - ---------------------------------- -- Phone----26L-_ 0062------------ Address--------------------------- ifornia--------------------------- -------------------- --------------------- - ,. D.A. Parrish & Sons Inc. Phone_---456-9607---------- Contractor's Name------------ --------------------•------------------------------------------------------------------------------- -- Installation will serve: Residence ❑ Apartment House ❑ Commercial FK) Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms -------- Number of baths ____2__ Lot size --------Ac_era,ge________________-_______________ Water Supply: Public system Ej Community system ❑ Private ❑ Depth to Water Table �Q'_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ® Clay ❑ Adobe ❑ Hardpan ❑ 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----NIP.-----Distance from foundation----7.0_----------Material---_ConCre e-------_---------------- ® No. of compartments--------2---------------Size__6'---x-_7r--- ---9_1_Liquid depth-------54,11----- p y--- ______Ca aci# 1200__ga.7.. Disposal Field: Distance from nearest well...NA_------Distance from foundatio 20_°___._____.Distance to nearest lot line--------"'______ ] Number of lines---- ----------------------------Length of each line-------- T--------------.Width of trench----__.24"_______________-- \ Type of filter material------ IR------------Depth of filter material __ZS.t__________-Total length__-____..___---Ot. Seepage Pit: Distance to nearest well-------N/A-------Distance fr m foundation____40.1---.--- Distance to nearest lot line------- ] Number of pits------- ------------Lining material---SR.______---Size: Diameter----3311___---_--.Depth---___.25_-------------------- Cesspool: Distance from nearest well-----------------Distance from foundation---.---------------.Lining material-------------------.__.____.__.______ ❑ Size: Diameter---- -- ------------------------------Depth---------------------------------------------------Liquid Capacity-------------- -------------gals. E __Distance from nearest building -Privy: Distance from nearest well------------------------------------------- -- 9--------------- ---------------- - ❑ Distance to nearest lot lire- -------•-------------------------------------------------------------------------------------------------------- ---------------------- Remodeling and/or repairing [describe]_----------------------_______________ZInstall__ -2©0___ c. Sept]e-tank} 0 1•f. of leach line and one-3-311--di dia.__X 251 deep seepage__p t' !------------------------------------------------------------- ------------------- ---------------------------------------------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�_-Wof 5 •-------------------------- ----------------------------------------- -------(Owner and/or Contractor) By:------------------- ------ -- - -- ---- - - --- -----------------------------------------(Title)------ES_timator----------_------- -------- (Plot plan, showing size of lot, In relation to wells, buildings, etc., can be placed on reverse side). F R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_. _.-Y _. --------------------------------------- DATE.----�-�'�� ------------- - - REVIEWEDBY------------------------------------------------------------------- - --- --------------------------------------------------- DATE---------------------------------------------------------- BUILDINGPERMIT ISSUED------------- -----------------------------------------------—-------------------------------- ----- D/ TE---------------------------------------------- -------------- Alterations and/or recommendations:--= � --1-tF--------0„��'-- �---- (0f .-_ j ' -------------------------------.------------------------ ---------------------------------- ------------------------------------------------- ------------ --------------------------------------------------------------• --------------------------------------------------------- ----------•----------------------------- - -- --------------------------------------------------------------------------- --------=----------------------------------- ---- ------------------------------------------ FINAL INSPECTION BY:.-- aC -- --------- Dafier - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Koxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.RrG.