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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 incompliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION------ MXd-- 120 R411ro94-Ave. Stockton ---Cal--i'. Owner's Name-----Ed!,r��hd �r' C�rcaen�e� ---------------------------------------!--------------------------- ------------ Phone Address________________3120-- Railroad Ave2---0-3-1-2-- -- 5 o ckton Contractor's Name------ -�___�___._. 'ASH__& 0_%3S� INC. --- --- ------------------- ------------------------------------------------- Phone---- --- - �'-8-59'7------ ----- � } Installation will serve: Residence M Apartment House ❑ Commercial El Trailer Court ❑ Motel ❑ Other �1 Number..of living units: 1] Number of bedrooms ❑ [� Number of baths Lot size------------t-•--�---'7,5-;--'------___--- Water --- Supply: Public system ❑ Community system [] Private Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [3 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------3'Z�-- Distance from foundation-.--.__�" f CEP.7eni, Blx 129 _-_-"-.Material_-Q i rc---_-----_ - -of compartments---------•--2-_---------Capacity-----$009---------Size_J�ire` Liquid depth_------�2EI------ ---- Cesspool: Distance from nearest welt----------------Distance from foundation-___--------_______.Lining material----------------------- 1771 --------- Size: Diameter--------------------------------------Depth----------------------------------------------------- Privy: ---------------------- ----------------------- - --Privy: Distance from nearest well----- _ _____-----__-__----Distance from nearest building------------------------------------------ Distance to nearest lot line____________________________ Seepage Pit: Distance to nearest well__-------------------Distance from foundation--------------------Distance.to nearest lot line--------___-_--_ ❑ Number of Pits----------------------------.-Lining material--------•--------------Size: Diameter------------------------Depth---------------------------- Disposal Field: Distance from nearest well_--- I2--_-._.Distance from foundation---.2$-�_______-Distance to nearest lot line_---._5_�--__.-- 129 Number of lines--t_------�'----------------------Length of each line--------2.5_-____--------.Width of trench--------- ��-------__- Type of filter maferial------3-1-1IRk--_--Depth of filter material_-__-1211 --_______ Remodeling and/or repairingdescribe --- ---------------------------------------------- - - ------------Repl e n e fitinR Se��ic tank d adding each main Dario to en'r;erin ----------- x; tnumn- ----------------Y- -- h ----------- --------------------------------------ertiy ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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 regulations of the San Joaquin Local Health District. A(Signed) �.,_---P T_3 &-IX;P- r TEC_. Q- t.-----------i -- ------------ fbr Contractor) A---- --------(Title)---------EBti � -�nring size of to+, location of s stem in relation to wells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-----------------------& — ------ ---------- DATE----.__---- s REVIEWED BY------ -----------------•------ BUILDING PERMIT ISSUED------------`---� _-- DATE ------ ----------- - --------------- -------------- DATE----------------------------- - A aerations and/or recommendations---------------------------------- -------""--"------- ------------------••--- -------------------------------- PERMIT No._ o __ ---_-- ISSUED--------- - - -- -------.-(Date) FINAL INSPECTION BY:---------WJ11/ ------ ---------------------- Date -- -- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES--9-2M 4-50 W-1639