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APPLICATION -FOR SANITATION PERMIT y� (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. • 2-..0�f Gam®J'� S T JOBADDRESS AND LOCATION------------------------------------------------------------------------------------------------------------------------------------------------------------------- Owner's of Grove and Hunter Streets Owner's Name------------------------------------------Domenico- La-11i----------- -------------------------------------------------------- Phone --_NWe-------------------- Address---------------------------------------------------- E. A ine--S r -e ---------------------------------------------------------------------------------------------- - Contractor's Name---------------------------------D_.--A.-- P.ARRISH---& SONS-s-- INC ._.. -------- ------------------- Phone-----9t!-9 R7------------ Installation will serve: Residence [X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: M Number of bedrooms 01 Number of baths E]- Lot size--------5�l-_- 7.00 Wafer Supply: Public system ❑ Community system ❑ Private LX Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan 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-----50.1-----Distance from foundation-----101-------Material------C---L---Brick____- -----_- No. of compartments-------------- ---------Capacity-------BOO ----G--Size---56- " 6►!x63?.quid depth----------52.......... -3 --- Cesspool: Distance from nearest well__-------------Distance from foundation--------------------Lining material _----_------.---_____---.---_-_ ❑ Size: Diameter----------------------------------•---Depth--------------------•--------------------------- Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-------.--------- I ❑ Distance to nearest lot line------------------------------------------------ Seepage Pit: Distance to nearest well-'(517--------------Distance from foundation--------------------Distance to nearest lot line-----_------_- '[ ' Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth-------------------------_- -- -Disposal Field: Distance from nearest well--_--6Q1----.Distance from foundationl01-_------Distance to nearest 24line-- --�1-_------- Number of lines----------- Z------Length of each line---2.5-----&-- ��__-Width of trench---_------------------------------ 1}� f! Type of filter material- -a------ _---RkDepth of filter material-----1 --------- _ Remodeling and/or repairing (describe)------------------Ne-w---installation--------------------------------------------------------------------------------------- - -------------------------------- ---------------------------------------------------------------------------- ------------------------------------------------------------------------------ I hereby certify that I have prepared this applicafion and that the work will be done in accordance with San Joaquin Coun ordinances, State laws, and rules and' regulations of the San Joaquin Local Health District. Si ned D. A -PAR ISH 0 ;,S --10' ( �.Confractor) 1 (Signed) = By: - - -------------------------- (Ti+le) Estimat-Or (Plot plans, sho g sit a of lot, location of system in relation f wells, ildings, etc., must be filed with fhis application}. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------------------------------------------------- DATE f REVIEWED BY-------------------------- ------:---------------------------- ----- --------------------------------- DATE BUILDING PERMIT ISSUED-------------- --------- ------------------------------------------------------- DATE------------A5N----------------------------------------------------------------------------------------------------------------- -------- - Alterations and/or recommendations:--- .--_----------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ---------------------------------------------------------------------------------------------------;----------------------------------------------------------------- ---- ---------------------------------------------------------------------------------------------- --------------------------- !L PERMIT No Iz_.. - -ISSUED------- _. --4r ----(Date) FINAL INSPECTION BY------------- ---- -------------'--------l!----------------------- Date----------------- / --- - C---------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 5tock+on;California \ ES-9-2M 9-50 W=1834 °�