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� ,`5-,L/ APPLICATION FOR SANITATION ON PERMIT Permit No.�-„�,.�-X- I(” (Complete in Duplicate) �f Date Issued .__. -1_.fp: ._s� 7� Application'is hereby made to the San Joaquin Local ocal 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------S_-_ervice Station on North-East Corner _ f Pacfic t& Porter. -- ---- - ----- ---------------- --------------------------------------------- Owner's Name -----•-------------------• -ener Peroeum---QOr-- ------ Phone----------- •------------- Address P- --Ba __Na �-.5�9.._ Stockton a$ 3 D� o(" ---------------------•----------------------------------------------- ---- -------- Contractor's Name--------------------•-••-----=-PARRISH---INC. g•—�60rj , -----------------------------................. ............................. Phone-------- ---- -- i Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trail r (; urt ❑ ❑ Other i c Motel o l� sStation t l e t Number of living units: Number of bedrooms -------- Number of baths ._2___ Lot size __- 1 1 � �4nn Water Supply: Y stem.Public-system ❑ Communitys ! s❑ Private � Depth to Water Table ________ ft. Character of soil to aj depfh of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑' Clay Loam ❑ Clay ❑ Adobe .� Hardpan ❑ Previous Application Made: Yes ❑ ; No $] New Construction: Yes IN 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 --------- Ifromf�undation_2�t IN No. of comp artments....a--- --- - 940 b -----------------Material-----C C'---B-Y'�.CSL p Size - Liquid depth----5 " CaPacitY 8-aQ G 18 p t} c'i eep E Dis osa€ Field: Distance from nearest weli... Distance rpm foundatiori____a-fl.---_----.Distance to nearest lot line___-- _. __ __ ------... Number of lines_________ _______ _ Length of each line_____l��___-._-___--_1Nidth of trench.____..._��'��-__-___. _ Type of filter materia€_____1 _�1_ Rk li __._.__Depth of filter material___. Dl --_Total length--------- _____-_l b6 _ _ ji ' Seepage Pit: Distance to-nearest well-.__-________________Distance from foundation__________-_--_.__..Distance to nearest lot line---- ❑ Number of pits----=-----------------Lining material-----------------------Size: Diameter----------------------- ------------------------- ------ Cesspool: Distance from nearest well-----------------Distance from foundation------------.-------Lining material-__________________________ -- d 5iSize.- Diameter--------------------------------------Depth----------------------------------------------------- Liquid CapacitY- --------------------------gals. Privy: Distance from nearest well_______________________ -----------------------'_Distance from nearest buiidin9 El Distance to nearest -lot line.... Remodeling and/or repairing_(describe):----___-`-'______------------------------ •i -------------- ------------•--------------------- ----------------I------ - 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)-- ------------ Signed)- ----- ` --- ------------------------------------------------------------------ ---- { aer`lsvlrb Contractor) 8Y� = ?�--. {Title)--Et t�mator ----- ---- ----------------------- P of plan, shoy4n siz o lot, location'of system in relation f wells, buildings, etc., can be placed on reverse side). FOR`DEPARTMENT USE ONLY APPLICATION ACCEPTED BY___ ...____----------------------------------------- - -----•-----•---------- ------ DATE REVIEWED BY ---- ------------------------------------------ ----- ---------------------------- BUILDING PERMIT ISSUED DATE------------------------------------------------ == ------------- DATE- �Z, Alterations and/or recommendations:---�----------------- ----------------------_--. --------------------------------------------------------- { ---•---- ---------------- -------------------•------ -•---- ------- -- ----------- - ----------------------------------------------- ------------ ------------ ---------------- - - FINAL INSPECTION BY:------- L_{'i'1' - E. -------------- Date---------- ------� t �. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 1 30D West Oak Street 132-Sycamore Street 814 North "C" Stockton, California Street Lodi, California Manteca, California Tracy, California ES-9-2M J0-52 Revised W-2100