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APPLICATION. FOR SANITATION 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 compiiance''with County Ordinance No. 549. JOB ADDRESS AND LOCATION----.------$-5Q_.-We_'st--Main Street Stcc-kton" Calif Leo L. Ferrera - 3-- 3 Owner's Name----------- --- o---- -------------------------------------------------------------- --------------------- Phone-----------�82 85o__Vest---r"aJ__n_-_S t-� St r:`ct r_n mr Address------------------------------ ------------------------------------------------------------------------ -I-------------------------------------- .,.� Contractor's Name • `-- :' T SJi?,5_a -zgTC. ----- Phone---9,.99 0�j~ Installation will serve: Residence M Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: . Number of bedrooms QJ! Number of baths ❑LL. Lot size---------5-7.1----x---3-501------------------------ Water Supply: Public system [Z Community system ❑ Private ❑ Character of soil to a depth of 3 feet: Sand Gravel Sand Loam Clay Loam Clay Adobe Hardpan p ❑ ❑ Y ❑ Y ❑ Y ❑ � ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: V (No septic tank or cesspool permitted if pu6h; sewer,is available within 200 fee+.) j being used r COs1C C c Septic Tank: Distance from nearest well-_1 ______Distance from foundation_____10-1------- ❑ No. of coin artments______-_2_______________Ca Capacity 9QQ---(tizez'Qiit1Liquid depth ________52--------_--._56�-x3 6 1v .� Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material__-_---_______-_--_____---_-______- ❑ Size: Diameter--------------------------------------Depth----------------- --------------------------------- Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_______----_.---_-__-____-______-_______- + Distance to nearest See�ge Pit: Distance to nearest I\o�liin ------------------^Distance from foundation___,:" .2�__.Dis=ante to nearest lot line__-. Q1___ __ KI Number of pits-------J- _- ------------Lining materialg9!! u XSize: Diameter----33--------------Depth--------- Q------------------- ¢ Disposal Field: Distance from nearest well--------50'-Distance from foundation______ -------Distance to nearest lot line----101-_____ i Number of lines________3------------------------- of each line----------5Q--------------Width of french__________21__'_'----------------- Type of filter material_._. --___ k___Depth of filter material__-______� rt__ ___- - - Remodeling and/or repairing (describe:.--------KeX---l_Aata_lt7 RR______________ ---•-•----------------------•-------------------------------------------------------------------•------- ._.-------------- -- ------- --- --------------------------------------------------•--------------•------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ I --------------------------------- I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and' regulations of the San Joaquin Local Health District. 1 (Signed)------ A P -asr� & -ons Inc. --------------------------------------------------------------(O�n�� Contractor) •------ r _ --------------)Title)------Etnt-fix-: (Plo+ plans, owing size of lot, location of s#em in rela+ion to ells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------ -------------- DATE------------- --- • -- - -- -------- REVIEWEDBY-------------------------------------------- --- -------------------------------------------------------------------- DATE------------ --------- ----- ---------- ----- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------------------ Alterations and/or recommendations---------------------------------------------------------------------------------------------------- ------- Q ----------------------------------------------•-•----------------- ----•-----------------------------------•------•----------------------------- -------------------------------------------------------------- ---------------- i PERMIT No...3--!_'r--------- ISSUED_____-_ `,` " (_________(Date} FINAL INSPECTION BY______________-_ Date--------------------- ; A � -------- . i , ' SAN JOAQUIN LOCAL HEALTH DISTRICT , 130 South American Street Stockton, California ES-9-2M 9-50 W-1639