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w 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-------------------------23.5-.Wei-t----6t-h.---Street------------------------- -------- --------------------------------------------- enry----Hi&ashi - ---------------------------------------------- Phone-------Z "62 9----------- Owner's Name----------- --------- ----------------- -------- -- -H--- -+-- y-- ----�+ Address---------------- -----------------------13.5---We-st-- 6th.---S ix 8e-t--------------------------------------------------------------------------------- D- p RR�SH__s3s- SrJ ---I"aC -------0-------- Phone-------- -96W---------- Contractor's Name--- ----------•----------------................... ------- -------- -�..---- Installation will serve: Residence [; Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [I i Number of living units: -M] Number of bedrooms EP_ Number of baths] Lot size---------- 51=41----------------------------- _ , Water Supply: Public system JX Community system ❑ Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [X 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 0-ne Distance from foundation----la� -------Material--___G_Q�1o_-Ci�_c----13'rick it it r: No. of compartments - Capacity 9QOG Size--:--56113�? 7�? iquEd depth------- 1)Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- ❑ ---------- Size: Diameter----- ---------- ---------- ------Dept ---- ---------- ------- ---------- __________Distance from nearest buildi6g------------------------------------------ Privy: Distance from nearest well________________________-_-_-____. -- `-` ❑ Distance to nearest lot line------------------------------------------------ t. . Seepage Pit: Distance to nearest well_____Ndne _ Distance from foundation___2 �______-Distaice to nearest lot line_'__-- ---_-- -- -Lining material---- -onc Size: Diameter-----3.3-------------Depth_--------15----------------- Number ----- ---- ----- Number of pits--------�.---------- L�1°G BT t �7 1' _______.Distance to nearest lot line--______`7-_____ ,Disposal Field: Distance from nearest well___N-0, e__.Distance from foundation____ Number of lines______---1-----------------------Length of each line-_________-�i�_--------.Width of trench_________ t�________________ Type of filter DepthmateriaL____�. ��---Rk-- of filter material----1$_.-_--.___-_ Remodeling and/or repairing (describe) ---------Ne �• A1�'11�-_�4_ _ : --------------------------- -------------------�----- ---- ----------- --------------- ------------------------ - r- ______ p p �t.� a.,a District. - ---an - ----------------------------------- ----------- --oa -- C State laws and rules and regulations of the San Joaquin Local Heal with-San Joaquin County { hereby certify that I have prepared this application and that the work will e done in accordance with ordinances, S 7, A,--PARR25H--&--SONS I----Wq- ---------'-------- ' Contractor) (Signed) ---------------(Title)-------EST IMA' OR-------------- ------------- ---------------------- -------- --- -- By:----------------------------------------------------------------------(Plot plans, showing size of lot, location of system in relation to wells, b-uildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY , r �! DATE---------4- - l-- / APPLICATION ACCEPTED BY_________________Gam-'--�---- - ---- DATE -- --- ------------------ REVIEWEDBY-------------------------------------------------- ----------------------------- --- --------------------- ------------------------------------------------------------- BUILDING PERMIT ISSUED---------------------------------------------------------------------------------------------------- _ DATE--------- ------------ ------ - ------------- ------- Alterations and/or recommendations------------------------------------------------ ---------------------------- ----------- ----- ------ ----------------------------------------------------------------------- -------------------------------------- r PERMIT No��----- ISSUED _-- ------- ----`S--/------------(Date] FINAL INSPECTION BY:---------- ----- --- ------------------------------•- Date - -`--" � SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W=1639