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APPLICATION FOR SANITATION PERMIT .1101111 (Complete in Duplicate) Application is hereby made to the Sen Joaquin Local Health Dis Frlct for a permk to construct and install the woA herein dere:bed. This application is made in compliance with County Ordinance No. 549.. JOB ADDRESS AND LOCATION...Ht...l,..BOX-.6/,/,r..3tncktony.'ti:Ngy...99-.3oatb,..a�xL..to-.. ... Q. •� 1 Owner's Name...........TOAD:.. ...,Epi.e ......... . _ ............................. Phono_..__.Ho7u..:.:_.._. Address.......................I.. .. ....:....40M0.............._.............. . ,'. Contractor's Name............... . ... .II...A...PARRI3i..&..SORB, INC ... ..----------------------------- Phone .......9-96117 _ t '„ . Installation will serve: Reridenen Q Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ® Number of bedrooms [:%, Number of baths [} Lot size......Z.-Mi vAr .......... ...... Water Supply: Public system ❑ Community sys4ern ❑ Private Cid Character of soil Is, a depth or 3 feet: Send ❑ Gravel ❑ Sandy Loam❑ Clay Loam ❑ Clay❑ Adobe M Hcrdpan TYPE OF INSTALLATION AND SPECIFICATIONS: +•�;�. (No septic tank or cesspool permitted if public sower is available within 200 feet.) >� Septic Tank: Distan:e from nearast well.. ..........Distance from foundation ......... ..Material. ......... ' ❑ No,of compartments...................... a Capacity ._Liu p P CP /........ Size................ ....... q %J depth r , Cesspool: Distance from nearest well................Distance from foundation .................Lining material...... s, ❑ Size: Diameter............... .... ....Depth.................................................... Privy: Distance from noarest well .... . . .... .. .Distance from neares'r building ❑ Distance to nearest lot line ................................ p "• Seepage Pit: Distance to nearest well i0.0s• Disfence from foundation .Distance to nearest lot lire ,501 S 17 Number of pits......] ...... Lining material..... Diameter ....3.as..:: Depth 5. t Disposal Field: Distance from nearest well. ...... .....Distance from foundation....................Distance to nearest lot 11,16 ❑ Number of lines...... Length of each line.. Width of trench �atr, Type of filter material _ Depth of filter material ' Remodeling and/or repairing (describe): .:..._`rte.PP12Y..7h'§j-p888 -------:---- --- _- .................. ............ .... .. ..... . ............ _. ... .. .... t _.. .. ..... ... ..... ...... ..... . .. ..__ ..._.._,_.. e n 1 heroby certify that I have prepared this application and that the work will be done in accordance with San Joanuin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health Dist•ict. (Signed). .... l SH ..SONS._5m.. .. . ( rdra u c ,nQc\ Co ctar9 By: 1.-.@C.._M1Y. _._ . ... .. .... ..(Title) �,.OT.._-- _.. (Plot.plans, showiise of lot,location of syst in relation to wells, bw.. -igs, etc., must be filed with ,his opplicafion}. ' FOR DEPAP..MENT USE ONLY e APPLICATION ACCEPTED BY . DATE -.- --- _.. REVIEVCor) PY __ ..... .... . DATE /� �..._-�� ... BUILDING PERMIT ISSUED .'/..y�L% ...... �. .. .. DATE. . . ...... Alterations and/or recommendations!......................................... ... .. . ... . ... ..... ..... .... . .................................................. PEPN,II No..... . ISSUED................... .......(Dare) FINAL INSPECTION BY .. ... 1 Data......................d/ . SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES.-9-7V 9-SO W.1639