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d� 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---- 105--No.--- a11_ Streets Sto-cktan,--_Calif. Owner's Name___PR9Z LeVi8----------- --------- - - - -- ---------------------------------------------- --------- --------- -- ----- ---- ---- -------- --------------------------------- Phone_3-3798--------- ----- Address------------jQ5__;R9.j X_ ;. S%r6-Bt- _ - - -- -- ---- ---------------------------------------------------------------------------------------------------------------- -Contractor's Name-------N---Ao-__FBrr�.eh & $oris_._ Inc. 9-9607 - --------- -------- -- ----------------- Phone----------------------------------- -------------------------- - -.Installation will serve: Residence X] Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [❑ Number of living units: -1 Number of bedrooms 2 Number of baths ❑ 1Lot size_____5 1X100E _ -------------------- Water Supply: Public system IX Community system ❑ Private ❑ (� Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 31 Hardpan ❑ V1 TYPE OF INSTALLATION AND SPE IFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from founda+ion--------------------Material❑ No. of compartments--------------------------Capacity----------------------Size--------------- ------- ---------- ----Liquid depth---- -----�-- --- � Cesspool; Distance from nearest well-----------------Distance from foundation___________________Lining material__________._______-_________ - Size: Diameter--------------------------------------Depth---------------------------------------------------- Privy: - ------------------- - - Privy: Distance from nearest❑ well__________________________________._______ -Distance from nearest building Distance to nearest lot line___________________________ Seepage Pit: Distance to nearest well___ 5 N�Ii:B-____-Distance from foundatian--1Q-------------Distance to nearest lot line______-t-_-----_ ® Number of pits___3-------------_ Linin ma+er' IC-:Lrc*Cori M 9 - _ ------------- _ __ size: Diameter____ Z M 3--------------De Dept art-ck-- -- --- - ! p Disposal Field: Distance from neaI esiwell--SO1Ze--Distance from foundation__10___________Distance to nearest lot I e___$_�_--_____ ® Number of lines___ ______1__---------____Length of each line--------_1-5_@----------- Width of french-------- Type of filter material.-__*"_-_ ---Depth of filter material-12 -_ under -Remodeling and/or r-epairing {describI)____________________ ------------------------------ - -----------------------------------------------------------------I---------Supplement to exi ting- drafnage___syatem--------------------- ------------------------------ p p-•--9----------�p------------------ -------- ---------------- herebycertifythat 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. �. A. r (Signed)-_--_ ----_- ;AARISH & SONS B � � �� -- - -------- - (�r Contractor) f (Title) Etimator--------------------------------- _ _ � � (Plot plans, s/ oWl g size of lot, location}of system, in relation to wells, buildings, etc., must be fled with this application). FOR pEPARTMENT USE ONLY _ APPLICATION ACCEPTED BY------- -- ---- -------- ------ DATE--- �--�-'?`-�--J-/ ------------------------------------------- -- REVIEWED BY ------------------ ---------- --/� /3 -f r ---------------- DATE---- �C = '. BUILDING PERMIT ISSUED---------------------------_ - ------------------------- ---- -------------- ------------------------- DATE Alterations and/or recommendations:___L------------------------------------------ ----------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------- - --------------------------- - . -------------------------------- _ E --------------------------- 11 - ------ ---------------------------- - PERMIT No.___41q-:!------ ISSUED---------'_-- ---- I' l �� -�-'�_--��___.--(Date) FINAL INSPECTION BY:-_-__-- "-v.---_-- Date--__-- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street ES-9---2M 9-50 W-1639 Stockton, California