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y!APP (CATION FOR . PERMIT• Permit No. /1 -------------------- 1 ��3 (Complete'in Duplicate) Date,lssuecl __ I,,/ 46 Applica�i%n`is,hereby made to the San`Joaquin Local Health District for a permit to const rust and install the work herein describe This apph`ar 'h is made in compliancefwith County Ordinance No, 549. ocATloNs - ---- 11 Sal Laurel St._.�__.5tk'_n.-------��-if. JOB ADDRESS AND L Phone---�q-=---�-• ------ Owner's N me__.- Y I igge_ = . ---�•-- Address _ �0� ---r'- a5 '_ -�aek9Pn ---Stk--11,,.+ D _ is Se -tic `dank Service Inc Phone---Hox___"" `�7 -� ---- Contractor s Name-----------� -•-------------�- '-----------•----------- -----------_ ' M Motel Other k • 1 Apartment House ❑ Commercial ❑ Trailer Court ❑ _❑ Installation rill serve: Residence Number of living units: ___ Number of bedrooms _ _-_2. Number of"bath Lot size __--6d-�---©�----------------------------------- Number --•----------------------- - Water Supply: Public system ® Community system ❑ Private Ro Depth to Water Table _35- ft. Character If soil to a depth of 3 feet: l Sand ❑ Gravel ❑ Sandy Loairk ❑ Clay.Loam ❑ Clay ❑ Adobes] Hardpan ❑ Previous Application Made: Yes ❑ 1 No CSC New Construction:,Yes Fdt No El a TYPE OF INSTALLATION AND SPECIFICATIONS: (No 'septic tank or cesspool permitted if public sewer is available within 200 feet.) ! Septic Tank: Distance from ned rest well-----------------Distance from foundation-------------r Material--•-_------_--------------------------- k1- -----------------•------ - --------- t k, EXi�jing No. of compartments___-_-___-_ _ Size .L�iquid depth--------------------------CapacitY---------------------- Disposal Fuld: Distance from neLrest well______----______Distance from foundation_____:r____-__._'.Distance to neaWidth of french--------------------------------lot line-------_-------- . Exism3ng Number of lines.( I---- -------Length of each line------------------- ------ Type of filter ma erial___I---------------------Depth of filter material... -yTotal length____------------'--------------------•- ' 5-' p 15"---------------- Seepage Pit: Distance to nearest yell ----------Distance from foundation---- 2 . _.Distan�e to nearest I�t i` e___ S; f2� _ - De to �. ® Number of pits.____::.---• -----Lining material___TOC}.S.__--.-.Size: Diameter_.______ �. r ` _. ...... _ _ ,� T.w Cesspool: Distance from ear v$el]___________.�__Distance~from°foundation___----"'""^"'�`hnie�� gals. I ❑ Size: Diameter, "f --------------- ------Depth----------------------- -- r-�-'"Liq'u d Capacity Privy: jc Disfance,,fro+m-enearest well----; - "r ----Distance from nearest building------------------------------------------ ❑ �.�.� Distance togrvatvTlo me--------- ---------=------- = 4 f . � Y . . �ac�d�ng---seepage,--piteto---exl�t�ng_--ay9t�m.--------adding--- Remodelin and/or. repairing (describe)_________________ ! two 33 x15 f't� seepage pits_ to -exieing---Ay- tem_-due--- v---cla_e®nest---off'--W�]� ---and topvraphy __of the .lot. ----------I ------- ------ ---- ----------_-------------------------------------------------------------------------- 6grj�ph ------i------------------ ------------------ 1 hereby certify that have�pre red.this app ea ion and that the work will be done in accordance with San Joaquin County " '� C 6 nC a Kcal Health District. i ordinances, State laws�nd rule�nd regulation s�of the San Joaquin L� - n4�1ta -Septic _T--- _I`� 1---._. -+------ �' Owner and/or Contractor) (Signed)----------------•- - -- -- : , •1r t Tale Gen. Mgrs By:_. _�/1'-Oxy---�dar_tha»---------------------••------.�;--�-., -- ----------------- ] (Plot plan s owing size of lot, location of system i relations tp�lwelIC-building eft c, can be placed on reverse side]. ! x / FOR DEPARTMENT USE ONL4 �' .~ ' i --------- DA E--- �+- ------�`�----------- APPLI6ATION ACCEPTED BY------------------------------ + ,kE I ----- �~---------- ----------------- DATE---- -----•`- �-;w � l RE'�EWED BY BI1ILDING PERMIT ISSUED------------------------------ -- --- ---------- ----------------- DAT=E--- ---—--> - j f �. ___ .___ _