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--�- 6 70 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, JOS ADDRESS AND LOCATION------------ E. 12th. Street - -------------------- ------ --- -- ------------------------------------------------------ Owner's Name--------------------------------------------Ted—�'Q4 1xe e ------------------------------------------------- Phone----None r Address---------------------------------------------------------1818 ---------------------------------------- _ -1818 E. 12th. Street Contractor's Name------------------------------------D#---15i......Parri-8h---&---r30ng,---14-c-------------------------------- phone---9f!!96Q7-------------- Installation will serve: Residence IZ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ i Number'of living units: ] Number of bedrooms J] Number of baths [Z Lot size---- S' ; Water Supply: Public system ] Community system ❑ Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe EX Hardpan ❑ N I 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---NQIle-__Distance fr m.foundation__�__z1p_t__ Material----�+QnC--(�11'£---Br'Lck- No. of compartments________2______-______Capacity__600--�*_--___Siza7"p_R-6-----fiX Liquid depth___ 2�___ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material____--______________________---__. ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------- .-Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ El Distance to nearest lot line---------------------__________________________ Seepage Pit: Distance to nearest well__X59- --___Distance from foundation___________________ Distance to nearest lot line----------------- } AW ) 0 Number ofpifs----------------------Lining material-----------------------Size: Diameter------------------------Depth-------------------------------- ,.Disposal ------------ --- ,.Disposal Field: Distance from nearest well __NOneDistance from foundation .......Distance to nearest lot line__-_5-`---_-___ Number of lines__________________��i __ Length of each line_______ ___.................Width of trench----------- �' ______________ -- ------- --- Type of filter material----a-P.__----Rk---Depth of filter material---Z$______________ -Remodeling and/or repairing (describe):-------New installation; * ; Floyd Tract. ------------------------•----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ 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. Perri . & S s IriCo ' ontractor --- ---- -------------------------------- g 1 --.:--- ----�--- ( 1 $Y' t��;, �� (Title)....Esti.mat—r--------------------------------- (Plot pla�s, sho ing size of lot, location of system in relation to wells, buildings, etc., must be fled with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------------- `"' DATE--------- - -----=y(------ -------- REVIEWED BY----------------------------------------------------------- j^ a- � ) --------------------------------------- DATE--------- ------- �., �---------------------------- BUILDINGPERMIT ISSUED-----------------------------------V--------------------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations------------------------- --------------------- ---------------------------------------------------•--------------------------------------- ------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------- _------------'--•------------------------------------------------------------------------•--------------------------- PERMIT No.____\�,-- �____-- ISSUED----mss` `- ------------------(Date) FINAL INSPECTION SY:---_ r ! "'�___-------------_---------------------- Date------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W-1639