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APPLICATION FOR SANITATION PERMIT Permit No. .._le��- (Complete in Duplicate) Date issued i. 0-7-0 Ce,p -27 Applicakion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work here des�rib . This application is made in compliance with County Ordinance No. S49. a between Kettl.emiam Lane &.._Bar,�en�_-..-_�`�'�:��4�'�_ X�k JOB ADDRESS AND LOCATION..�s urn W. and 2nd h6. Ori N. Sid ' -6738 hone-------� 8 Owner's Name MO1'3'- ---- r ,S T�? .€'7'. 4 .------ s - '��3 Off' . Addre-ss-------- - - 35 W. Lockford St. °d ... -------•----------------------------------------------- -----------� ----••---- ------------------------------------------- De1Lt ----------- ---------------------------------•-------------- ----------------- Phone. xQ•---- Contractor's Name------------------------��---------------------•---------------- Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ I Number of living units: -1---. Number of bedrooms ----2- Number of baths ._1.-- Lot size _50xL50------------------------------- ---------- Waters Supply: Public system ❑ Community system ❑ Private [2 Depth to Water Table _ Q_ ft. _ w Character of soil to a depth of 3 feet: `Sand ❑ Gravel ❑ Sandy Loam❑ Clay Loam E] Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No az New Construction: Yes ® No ❑ 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------�. -----Distance from foundation---4.C........- Material_-......0-..i1 eme-I.t----------------- �1 , i X11 i ------------Capacity---8a-Q---------- 0: No' of compartments--------•2------------ Size---------'-��•----``-=----------Liquid depth----�---�.. �Q... -..-..Distance to nearest lot line...-_�_________ Disposal Field: Distance from nearest well_.-...5Q___-_Distance from foundation.... , 7-5; Width of trench ��4k f: ® -- -- Type bof filter materal-_-_-riOCk--------Depth offfilter lmlaterial_-_-� .. .-._..._.Total lengtho _- .t ; Seepa Pit: Distance to nearest w IL../ ...--Distance rory undafiion-.-. ._.-------Distance' to nearest-lot line... Number of pits-------- ........Lining material IGf ----Size: Diameter.-.--------------------Depth------. ----------------- Cesspool: Distance from nearest well-----------------Distance from foundation--..----------------.Lining material--..-.------..---------------------- Size.: Diameter-..-----------------:.,-_- --=r Depth _ - T_------- — Liquid_Capacity - = 9 Priv a Distance from nearest well----------------------------------------- --- --Distance from nearest building___,____._.-_-___-_---------_- ------ - ❑ Distance to nearest lot line------------------------------ -------------------:.--------------- --- Remodeling and/or repairing (describe)=----------------ilei? ----•------•--•---------------- �- ---------------------------- .. . 4 Qom_ ---- ' �-- -------- . /--------- �_� ...�.cc T- ' = jC ----- ---------------------- --- I hereby certify that l have prepared t is application and that the work will be done i a cor ante with San Joaquin County i tions of the San Joaquin Local Health District. ordinances, State laws, and rules.and regula (Signed)----------D,e1t2----------------------------------------------------------------- .. (Owner and/or Contractor] ( h 1J, {Title] fir•------------ ------------- -------------------- BY:� --••-----------'--------------------------------------------- ------------------------- --- (Plot plan, showing size.,of lot, location of system in relation to wells., buildings, etc., can be placed on reverse side]. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_"_--------- -- ---- ----___- DATE.___:_ -------------------------------------------------- r ---------1------=-:_._--- ----------------- REVIEWED BY------------------------- --- I'� -------------------------------------------------------------------- ---- ---- DATE.S'- ------------------------------------------------- REVIEWED PERMIT ISSUED---------- ---------- -----•---------------------- DATE ` ---------------------------- Alterations and/or recommendations------------------------------------- ------- ---------------------•----------- -.----------•------ --------••--------------------------------- ------- ---------------- ----- -----------------• -------- FINAL INSPECTION BY:- -------=--------------------------- Date------- ---- SAN JOAQUIN LOCAL HEALTH DISTRICT I30 South American Manteca, California Tracy, California Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California ES-9-2M ; Revised W-2100