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APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Application is hereby made to the San Joaquin Local Health District for a permit to construcf and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION-------- bZ Pa_ci 'ic---Aye- -------Sto_C�Z_tcin_r--_Clali_f.-------------------------------------------------- Owner's Name-----------W-"-----a-`----W 4r'.c_efi_te-r----------------------------------------------------------------------------------------------- Phone------9-9z6-6------------ Address-----------------------6- 3.9 P r. f I-c--Ay-e------------------------------------- --------------------------------------------------------------------------------------------------- Contractor's Name--------D-'•---A A. PAR SH---& �Qx,� 3 jJ , Phone---g 8-597 - ------------i___-__-_-_----_R__-__ _ ________---__-- Installation will serve: Residence IN Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: io Number of bedrooms [B Number of baths a Lot size------ &Cre____ Water Supply: Public system ,E] Community system ❑ Private Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe IN 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------------------------------------------------- No. of compartments Capacity ------Size-------------------------------_Li th__--------------------- Liquid de :-- ❑ P P Y--------------- q P Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-_----_-____---_--_________________-_. ❑ Size: Diameter--------------------------------------Depth--------------------------------------- Privy: 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____-3-5*---.Distance from foundation-----3-5-1-------Distance to nearest lot line---1Q_E_-____ ] Number of lines______________2___ _____Length of each line25_'____.5(__'__...._.Width of trench_______2rk11____________________ � Type of filter material______; _11____Rk_Depth of filter material-____1211---------- Remodeling and/or repairing (describe):---------aUPPeM-erft--_-tQ--_-exlgti_a J_-$- .____l�-�r ,_ --_ _-_--L��Chi -------------- ��e5 �s�� x'� �n��__ne_ L--z-t---hJ s--na�.-nt---bu:1- a�7ay ��o-r -....en �1 �a_r��on off'_- rel # . e-----d1agram---m--------------------------------------------------------------------------------------------------------------------------------- ------- ---------------------------------------------------•-------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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, hayn�d�rules and regulations of the San Joaquin Local Health District. D o A• PARRS"SH & -SM1 7-----_��-�-�-----------------`-- vt (Signed}----- ----- ----- �- - -------------------�--------------------------------------I�aa Contractor) BY:-----------------------------------------------------------------------------------------------------------------------------------(Title)------- S�irkatoM------------------------------ (Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------ ------------------ DATE--------� +3 S REVIEWED BY------------------------------------------- U--�-- ---------- -- ---------------------------------------------- DATE--------I-1--- 1-3--r J e BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE--------------- Alterations and/or recommendations---------- ----------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------•-----------------------------------------<----------------------------------------------------------------------------------------------------------------•--------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------•--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ PERMIT No--- ------------- ISSUED----IC_�-!_3_ 5--------------(Date) FINAL INSPECTION BY:------ Nr -2--/--- ------------ ------ ------- - D ate---------------1d/JJ/-{--P------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W-1639