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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 construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION Vill- --- ---- - - --------------------------- � 5 Volny_ _Ave----------------------------------------------- Owner's Name-------il�IMO-17do--------------- XnbXM---(fir+---Villa-)------------------- Phone-----NOne-------------------- Address------------------- 3-335--Volney--- °e•-------------------------------------------------------------------------------------------------------------- Contractor's Name-------------------------------- � � p; rP15r1--&--S-ons-#---inq------------------------------------ Phone-----9``-9(5x------------ Installation will serve: ResidenceXlApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ] Number of bedrooms ® Number of baths Z] Lot size--------5Qt_ .50!_-_ Wafer Supply: Public system Community system ❑ Private ❑ ("�u Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe$] Hardpan ❑ �` TYPE OF INSTALLATION AND SPECIFICATIONS: J 1 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material------------------------------------_------------ El - ----❑ sprsp y---------------- -- -- Liquid depthth--------------------------- Cesspool: __----_______-- __-_- Cess ool: Dtace from nearest well-----------------Dtane from foundaton __-______________.Liningmaterial- _ - ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------- Privy: ------------------------------------------------- Privy: Distance from nearest well-------------------------------------------------Distance from nearest building__________________________________-_____. ❑ Distance to nearest lot line________________________________________________ Seepage Pit: Distance to nearest well---_None-------Distance from foundation-_-_-IOt-------Distance to nearest lot line______ 5t Number of pits_________I_________Lining material------ Diameter----33_--------------Depth----------201'___-�,--- ..Disposal Field: Distance from nearest well_Nona-__.Distance from foundation-----IQ._______Distance to nearest lot line---15t____-- --,,,,� x Number of lines-----1----------------------------Length of each line---------30!-------------Width of trench---------2-1-11----------------- F Type of filter material------- a"_---Rk Depth of filter material _________18"____ -Remodeling and/or repairing (d{erscribe):_____mm_---_-- -_ e) 2i ; ___ _ _41__-O _--e-XSlI1� 5C',pJ C______________ ----------------------- -aw_w_a.wa_------�I1L� .�e `--.-.4.rCact--------------------------- - ------ -------- --------- - --------------- --------`•----- --------- ------------------ --------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------- ----•--------------------------------- II 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) '-_A Parr ;oh - on5! Inc. . Contractor BY� ----------- -------- ---- ----- -------- ------------------------ ------------------------------------{Title)------K*illmatp ------------------------------- (Plot..plansel�i 7g ze flog; location of system in'relation to wells, buildings, etc., must be filed with this application). // FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------------------------ / 6 DATE cj REVIEWED BY ` --------------------------------- DATE_-------------- ----- ------------- ---------------------------------- - -- ------------------ BUILDING PERMIT ISSUED------------------------------ ----------------------------------------------------------------------- DATE-------------------- -- Alterations and/or recommendations----------------------------------------------------------------------------------------------------------------------•---------------------------------------- ----------------------------------------------------------------------------------- ----------------------------------------------------------------------------------- - ------- -------------------------- -------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------- --------------------------------------------------------------------------------------------------- ------------------------------------ PERMIT No._ ' -`{ ISSUED---- ---------- _��----.r--------f_/-yS------------(Date) FINAL INSPECTION BY:------------ ----------------------------------- Date---------------�/y-/Z/ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California F5-4-2M 9.50 W-1639