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�S APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Application is hereby made to the San Joaquin Local Health Distric+ for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. S49. JOB ADDRESS AND LOCATION----------------- 93_l -E" --debar Avenue _ --- -------------- Silvia & Micaele & Manuel Gallegos--------------------- Phone__3_!7n-5-------------- Owner's Name------------------------------------------I---------------------------------------- ------------------------------ Address---------------------------------X931---E.. -We_be_r___Avenue---------------------------------------------------------------------------------------------------------------------- Contractor's Name--------------D•-_&.-_PARRISH_-&-_SQ175-t---IXC-•--------------•----------------•------------- ---- Phone-__9-9607------- Installation will serve: Residence M Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: E, Number of Bedrooms [2 Number of baths M Lot size---------5Q XI1.fl1------------------------- Water Supply: Public system [3: Community system ❑ Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe N( 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__N0rPe___.Distance from foundation------lot------Material----------C-C--$r1Ck______________ XXI No. of compartments_--------2---------------Capauty__8-0-Q__-�-----_Size__--- -5,6j !_-- 6tf Y.631$lquid depth--------5?—s!---------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------ . ❑ Size: Diameter------•----------------------------- Depth--------------------------------------- --------- `Privy: Distance from nearest well_______________________ -------------------------------------------------Distance from nearest buildin g ❑ Distance to nearest lot line------------------------------------------------ 3-Zt---__-.Distance to near lot line_ QII_______ � Seepage Pit: Distance to nearest well----NQn ------Distance from foundation_____ daze: Diameter--- -_33 !--------Depth------------ Q1-- ------------- � Number of pits----___-_-__-_---_Lining material---C~-- T_3 � �Qt_____-Distance to nearest lot line---- Disposal Field: Distance from nearest wall__-__ •On .Distance from founda+ion--____ ___ X$r] Number of lines-----------1------------- -- g - ---- - Length of each line-------------- of trench-_--__-�_- tt___-_ - Type of filter material-------lV__3kDepth of filter material--------- -- Remodeling and/or repairing (describe:---------------------Ne-1+I---installation_.-------------------------------- ---------------- '-----------------------------------------------------_---- ----------------------------------------------------------------------------------------------------------•----------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and r ns of the San Joaquin Local Health District. ------------ (Owner and/or Contractor) (Signed)------ A PARRI & NS _.SNC. - By--- ---------- ---------------------------------(Ti+le)-ES tma .or [Plot plan sh wing size of lot, location of system i relation to wells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------- --- ----------------- --------------------------------------- DATE _- 6-- -. - --------wry, ` �* REVIEWED' BY---------------------------------------------------- - ----- -- --------------------------------- DATE----------------- / " "�1 ------------ ------- - -------------- DATE----------------------------------------------------- ------ BUILDINGPERMIT ISSUED----- ---------------------------------------------- -------------------------- -- Alterations and/or recommendations:----------------------------------------------- -------- ----------------------------------------------------------- ------------------------------------------------ --------------- J ------------------------------------------------------------------------------------------------------------------------------------- ------------------------- ,q- e . ` �x j .r � Date FINAL INSPECTION BY:----------W�------------------------------------------- PERMIT No.-��--. --------- ISSUED_------ xj9h (Date)� � ------ • s' --------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 9-50 W=1639