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APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) I Application is hereby made to the San Joaquin Local Health District for a permit to construct and install+he work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION-------- StOCkton-----------------------------------------------------------------=-------------------- w Owner's Name X----_NBT,f�OT1-----=--------------- --------------------------------------------- ------------- Phone - 3 I Address----------------•------------------------------------- ---926r--Stcckton--------------------------------------------------------------------------------------- Contractor's Name.----------------------------------n•--$+--_ ARRIS11__&----SONS.9---I21C'a----------------------------------------- Phone --9.607------------ Installation will serve: ResidencedMApartment House ❑ Commercial ❑ Trailer Court ❑ . Motel ❑ Other It 111' l units: -EX. Number of bedrooms F] Number of [� Lot size---_ --5PtX75______________________________ Wafer Supply: Public system Z Community system ❑ Private ❑ Character of soil to a depth'of 3 feet: Sand E] Gravel E] Sandy Loam ❑ Clay Loam E] Clay E] Adobe EX Hardpan E] TYPE OF INSTALLATION AND SPECIFICATIONS: Q (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well----None----Distance from mffoundation___10f----------Material------G---�e__$r'ick--------------------- Ir No. of compartments-----2------------------Caacit8aize____� 63m.Liquid depth------ 21t-.--------_-- Cesspool: Distance from nearest well----------------- 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----------------------Distance from foundation--------------------Distance to nearest lot line----------------- El Number of pits----------------------Lining material-----------------_-----Size: Diameter------------------------Depth--------------------------------- _Disposal Field: Distance from nearest well---None__._.Distance from foundation---14t________-Distance to nearest lot line---5=_--____ X Number of lines____.9--___Z---------------------Length of each line-----------7,5=_________.Width offrench------2'4R---_._________-___--_ Type of filter material------1.4-V__Hk....Depth of filter material--------1$!!`_------ -Remodeling and/or repairing (describe):--------Now-----instalUtIon-for-_sial1--offlea-_(--1---toilet__&--1aV'-a#401Ty)-------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ q ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ - I hereby certify that I have prepared this application and +hat the work will be done in accordance with San Joaquin County i ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. A � ' (Signed)-- ---- D�'QAt__PARRI-- & _o�.'__Q__NS._M*------------------ �--------------------- ---------------( Contractors B '�'1�/�+ -+- - --------(Ti+le} . Esti atter --------- Y= --- -------------------------------------- ------------------------------------------------ 0 plans, sho g size of lot, location'of stem in relation to wells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY 1 APPLICATIONACCEPTED BY-------- ------- -------------=- -------- DATE------------------------------ ----------------------------- REVIEWED BY------------------------------------ - a - -- --- DATE �`-'�." j " — --------------- �. BUILDING PERMIT ISSUED --------- ----A ------------------- DATE Alterationsand/or recommendations:-------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------x----------------------------------------------------------------------------------------------------------------------------------------------------- --------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ----------------------------------------------------------- --------------------------------- ------------------------------------------------------------------------------------------------------------- PERMIT No d___e' _ ISSUED ,p ---(Date) FINAL INSPECTION BY:------stu--- --- ----------------------------------- Date-----------------140---- 3-0 --------------•----- ' SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W-1639 I