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e c APPLICATION FOR SANITATION PERMIT Permit No. .-..l.-S__ :-� (Complete in Duplicate) - -- --.-,- - _ Date Issued Application is hereby made to the San Joa wn Local Health District for � f ` q a perr>art to construct and install the work herein described, !: This application is madein compliance with County Ordinance No. 54.9. / � 14V—c6vr 36 r��8 ..�6a-��oma.;.�;�',' • � ,. JOB ADDRESS AND.LOCATIONJ-7.Q -__ilk,.: Harbor Road N, Los--_Angeles St._ S—E_ Corner " . ! Owner's Name_----'S flcktQaa 511_i_p}---' -apply -_ Ho_ ---- ,T f� _- -. - Phon'e:– ---_ 42896 � ss PiCow- 112AddreSt-o_cktnn--------------------- --------------------- - - -- =V---- -- Contractor's Name-------.-- & SEPITCWANKSERICEHO - 0 ( _ - -------------- -- --------------------------------------- phone-- Installatiorwill . serve-:'-'-Residence ❑-"'Apat hent House ❑Commercial Trailer Court *V f ❑ ❑ Motel ❑ Otiter.,.� -' Number of living units: ---------Number of bedrooms -------- Number of baths 2----- Lot size ---12-5-1 Water"Supply:; Public system EjxCommuriity system E] Private E] Depth to Wafer Table -------- ft. S. Character of soil to a depth of 3 feet:, Sand 0, Gravel ❑ Sandy Loam❑ Clay Loam ❑ Clay ❑ Adobe ZK Hardpe:. �. Previous Application Made: 'Yes ❑ No [ZX New Construction: Yes ENo ❑ FHA/VA: Yes ❑ No ❑ 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__NO.C].t'_----Distance from foundation-----1Q1-------Material------- C---13riCk-----_'-. P 2-------------------Size-- ----- 411 rr-x-561!X--- ---Liquid depth-- Q... =-- - 1 Ca acit 1-0�}- -G. S r �X No. of compartments s 4 ii C�8 e t Capacity - - Disposal Field: Distance from nearest well--NDnP--'-Distance from fTndation---_19----_-,Distance to nearest lotline___.lo-_.,t $� Number of lines--- ----� �----------------Length of each line---- --- - -_-1 --Width of trench-------2- --...----,(24-_-_ Type of filter mate rial-e ?_�__-Rk_..-Depth of filter material__._----- 8tt----.total -Q'`--- -f _--- Seepage Pit: Distance to nearest well_--------------------Distance from foundation--.-----------------Distance to nearest lot line------------- _ ❑- Number of-pits___------------------Lining material----_______--_.-_._ - Size: Diameter------------------------Depth----------------------- Cesspool: Distance from nearest well------_____----_Distance from foundation------------------- material-----__---_-----------_-_-.--___ -. .•: ❑ Size: Diameter ------- Depth---------------------------------------------------Liquid Capacity-------- gal . Privy: Distance from nearest well-------_-----------------------------------------Dis#ance from nearest building ------------------------------_-------__ a ❑ Distance to nearest lot line-- -----7 = --------- �v Remodeling and/or repairing (describe):._R_est-aurant:__--_- 2�aCOT7n�Grs---s�_OOjs_;.--pZl�s- tabj_p5 ? ---- ---------- --------------------------------------- --- ----------- --------2-T-61lie-t_s-r--=---Kit Chem------ ---------------------------------------------- ;� t - ---------------------- - ----- ----- - -- ------ -- ---- -------- ---------- 'ti' - " -- -- 4----------------- I-hereby certify that 1 hav4pepared this application and that the work-will a_done in actor ante with San Joaqurn.,tiCo my ordinances, State laws, and rules and regy)ations of the San Joaquin Local Health District.'` - ak (Sig i1 DAY Be DIGHT ------------ ---------SE 1-C:-T--AN --SE-RWlGE--(M6y8T4 . Contractor) C Z�D5- iin�r�i� f� �5� a�if,. -- ------------------------- (Plot plan, s ao em in-relation to wells, bN&Wdf(Z--7 placed on reverse side). FOR DEPARTMENT.-USE ONLY APPLICATION ACCEPTED BY-------- -- --------- ~` DATE------ ------- ------ REVIEWED BY = -------------------- ----- --------- DATE .' j 0 "r BUILDING PERMIT ISSUED---------------------- -- -- ------------------------- DATE----- --------------- ------------------------•--------- Alterations and/or recommendations: F----------- ---------- ---------------------------------------------------------------------•--------...-------------•---------------------------------- f ----------------------------------------------•----------•-----------••-------------------------------------- ••--------- --------------------------------------------------------------------------•-----------•-•---------•-------------------------------------------------------- -----------:•----------------------------------•-------------------------------------------- ------------------------ ...- FINAL INSPECTION BY:-/ = = -- ----------------=---- Date 1 3 ---------- ---------------------------------------------------------- SAN JOAQUIN LOCAL!HEALTH DISTRICT 130 South American .Sfreef .30D West oak Sfreef� 1.,._,,..132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca,-California Tracy, California r ES-9-2M Revised 1.57 F.P.CO. ' i