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APPLICATION FOR SANITATION (/J) I ATION 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. s JOB ADDRESS AND LOCATION � 280 So. Wall Strew. -- ------------------------------------ ----------------------------------------- Owner's Name------------------ ------------------ ----------- ALVIN_ NUNLEY Address - ---------------------------------------------------- ------- Phone----None--------------------- -----------------2__$0-- 0_.---Wa11---Stre_e?t-------- Contractor's Name -----------------------------------------------------------------------------------------•-----------------� �..---�-Ar��}1---cQc_-�_OYa.�_ ZII C.------�--- ----- -- t -- Phone--------9-96-07---------- Installation will serve: Residence)M Apartment House E] Commercial [-ITrailerCourt [] Motel ❑ Other Number of living units: [IL Number of bedrooms 21 Number of bathssize ❑ i.. [� Lot ----•50t-�--�--�Q-� ---------------------- Wafer Supply: Public system Z . Community system ❑ Private p Character of soil to a depth of 3 feet: Sand E❑ Gravel ❑ Sandy Loam [] Clay Loam [3 Clay ❑ Adobel$ Hardpan ❑ TYPE OF INSTALLATION AND SPE CIFICATIONS: (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 No. of compartments--------------------------Capacity-----------------------Size-----"--------------------------Liquid depth------------------------esspool: Distance from nearest well------------------Distance from foundation--------------------Lining material____________________" Size: Diameter--------------------------------------Depth--------------------------- ---------------------- Privy: Distance from nearest well______________________________ _-_-_ __ -Distance from nearest building ❑ Distance to nearest lot line_________________________ ----------------------- Seepage Pit: Distance to nearest well-----K-Orie-----Distance from i-(m foundation----at--------".Distance to nearest lot line___5�_-"______ xx Number of pits------I-------------Lining 'material-----:-i---BrSke. Diametern - _____.3.3------------.Depth-------2V------------------ Disposal Field: Distance from nearest well----Nflna_Distance from foundation---- -----------Distance to nearest lot line____�� xx Number of lines---- 1-------------------------Length of each line-----------201----------Width of trench----•---2�FIt------- ------ T e of filter material_____ rt rr Yp -----.Rk_Depth of filter material--________�. Remodeling and/or repairing (describe)____________________D aill_-"Off_"Q LI3 I7 _"_�6SS 00 P ----------------•------- ----- ------------------------- ---------------------------------------- - ------------------------------------- -----••-------------- ---------------------------------------- prepared ---------.:-----------------------------------------------•-------------------------------------------------------------------------------------- I hereby certifythat I have re ared s application and that the work will be done in accordance with San Joaquin County ordinances, S e ws, and r '"reg tions of the San Joaquin Local Health District. (Signed)------- -- --- -- __ARR & ---'_na Inc e s = --------- -----------------------------( Contractor) :. BY:----- ---- --- ---------- --R------ - ------------------------- -- -------(Tifle)----- 4.stiwatox--------------------- (Plot plans, wing si3e of lot, location"of SYS 77 in relation to wells, buildings, etc., must be filed with this application). i I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY__-- _ _ I- " " �' c f' DATE ---- -- --- ----•----------------------------------- REVIEWED BY---------------------------------- -- ---------. DATE- _ � BUILDING PERMIT ISSUED--------------- I ---- ------- - ------------------------------------------------------ ---------------------------------------------- ------------------------- -------------------------- Alterations ----------=--------------- DATE------------------------ and/or recommendations:___� ---------------------------------------------------- ----------------------------------------------------•------•- ----------------------------- ------------------------------- - PERMIT No._----- "Q---"•------- ISSUED-- \—k7A--"�- ___________(Date) FINAL INSPECTION BY:--------- Date' , SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street ES-9-2M 4-50 W=1639 Stockton, California