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rpm- � 3� Z APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) 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-------------------838 South Anteros Ave. Stockton,Cal. --------------------------------------------------- Owner's Name-------•------------------------W13- i=.-- '---Cary--------- u----------------------------------------------------------- Phone----------- Q------ - ---- Address $ $ Q teros..Ave-. ,_Stockton,.-_Cal.-------------------------•------- -- --------------- o t� . Contractors Name................ •A+__.Parrish & sons:___IIIc-. -_ Pkone Installation will serve: Residence Ig Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ` Number of living units: X] Number of bedrooms Z] Number of baths Lot size_.-•-.-5Q_.....,X---12.5.................. Water Supply: Public system ❑ Community system ❑ Private N Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam❑ Clay ❑ Adobe i2g Hardpan 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---_--_-_-.----------__.-_____---____-_.-__- 7 No. of compartments--------------------------Capacity-----------------------Size--------------------------------Liquid depth---------------------- Cesspool: -------- --- ----Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material..._..-_.__._.....---------------- 171 - _ -__._-- ❑ Size: Diameter--------------------------------------Depth-•-------------------------------------------------- Priv : Distance from nearest well----------------------------- ____Distance from nearest building ❑ Distance to nearest lot line-----------------------_----------.-__-___-__-- -_ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line...... ,.` ❑ Number of pits----------------------Lining material-----------------------Size: Diameter..----------_...........Depth............................. Disposal Field: Distance from nearest well..351 Distance from foundatiory_ l 6 Distance to nearest lot line.--..�1 , . !�J Number of lines one Length of each lino._---. 5U Width of trench......._....................... Type of filter material.l- p_.-ropkDepth of filter materiaL_.`12" .-.__:-_ r Remo and/ �epairin ascribe):.. _.... ' -awQ ----------------- i I hereby certify that I have prepared this application and that t�will be done in accordance with San Joaquin Coin ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. r (Signed)-----------...-•-••-....nof mlocation h dna * - (Owner and/or Contras -------------- --------- ------------------- (Title)------------------------------------------------- By: President -�-- (Plot plans, showing si system in relati'oh4o wells, buildings, etc., must be filed with this;application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -------------------------------------------•------------ F ATE------------... --......- ---- REVIEWED BY-------------------------------------- --- -------------------- DATE.........../0-'----�6--=...;-"V................... BUILDING PERMIT ISSUED...................................................--------------------------------------------------- DATE------------------------------------------------------------- Alterations _nd or reed mendati s: ------------------------- --------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------•----------------------------------------------------- ---------•--------------•------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------- PERMIT No------------------------- ISSUED..........................................(.Date) FINAL INSPECTION- BY:__.WF!. _. . Date 1-0�' ._(-.4.s...---• ------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W=1639 `'