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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 compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION_____2703__E'___Po lar (2630 on house): Stockto.n� ----------------------- Owner's Name----------------------------------pZ-A ---$URBER------------------------------- ------------------- Phone---None--- ------------ Address - ---------------------------- -- ---- Address----------------------------------------------2629 E._-_Poplar Street --- -------------------------------------- Contractor's Name--------------------------J'-...._A__._Parri_9h-Rc--Spnsl---Ine---------------'-----------'----------- Phone_-9-960.7--------------- Installation will serve: Residence KI Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: [:0 Number of bedrooms [31 Number of baths [U Lot size-__----,50 t -_X3}0 t_________________________ Water Supply: Public system] Community system ❑ Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel"❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ® Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: y I (No septic tank or cesspool permitted if public sewer is available within 240 feet.) Septic Tank: Distance from nearest well__110_t____Distance from foundatio�10_!____b_��. ter alG_-_-_C+__BX`_ Ck_"___________. No. of compartments-----------2------------Capacity--800----G�------SJ - -•X3•----X6 ----Liquid depth---- ---------------- Cesspool: -------------Cesspool: Distance from nearest well________________Distance from foundation--------------------Lining material_________________-_________________ ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------- Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ 0 Distance to nearest lot line------------------------------------------------ 'Seepage ______________________________________________'Seepage Pit: Distance to nearest well___ l30bistance from foundation-----40-- ____4Q_Z______-Distance to nearest lot line__�-Q_�_____ g] Number of pits_-_�----------------Lining material__��-----_RI'i_C'i1�e: Diameter----33';-- -------.Depth-----X01-------------------- _ I Disposal Field: Distance from nearest well_I&I1____Distance from foundation__19_ ----------Distance to nearest lot line---10-1..... xx Number of lines________________l__-------------Length of each line------201----------------Width of french-------2�l:1'----------------- .__ Type of filter material-__1 ��___Rk_---Depth of filter material-----------UP-- Remodeling and/or repairing fdescribe):---------Hem---IIl_$_tiallati1. n-&—o----------------------------------------------------------------------------------- --------- ------------------------------------------------------------------------------------------------------------•------------------------------------------------------------------------------------------------------------- ----------------------------------•------------------------•------------------------------------------------------------------------------------------------•---------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ hereby certify that ! have prepared this application an4 that the work will be done in accordance with San Joaquin County ordinances, to laws, and rule regu ations of the San Joaquin Local Health District, (Signed)------- & 5 NS IN .. . . . . . . . . PARRI a - -------- ------------------------- -----------------------------------------�r Contractor) - - ---- ------- ------- - B ' -�' '•/ __7 (Ti+le)---E a i d dor (Plot ns, sho i g size o cation of system in relation t ells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY �Y APPLICATION ACCEPTED BY DATE - - - ---- --------- ------------ REVIEWED ---J- --- ----------------- r� BY------------------------------------------------------------------------------------------------------------------------------ DATE BUILDING PERMIT ISSUED--------------------- ----------------------------------- DATE ---------------------------- } Alterations and/or recommendations------------------------------------------------ -----------------------------------------------••------------••---------------------------------- i -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•------- ---------------------------------------------------------------------•----------------------------------...---------------------------------------------------•--- ----------------------------------------------------------- --•--------------------------•--------------------------------------------------------------------------------------------------------------- -----------------------------------------=------------------------------------- --------- ------- -- -------- - ---- -------- PERMIT No_____ ______ __ ISSUED------- --------(Date) FINAL INSPECTION BY:______________ _ _ -_ -- ----- ----------------------- Date-----------------------'"_c�-- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton,,California ES-9-2M 9-50 W=1639