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Permit No. APPLICATION FO, -PANITATION PERMIT 10 ^af p� I (Complefe in Duplicate) t � Date Issued ------14�l - Vx � Application is.hereby made to the San Joaquin LocaI'Heal tli District for a permit to construct and install the work herein described. This application ismadein compliance with County Ordinance No. 549.. . �t ------------------------------------------------------- JOB .,A AND LOCATION--------- - 2619 East Market__St ._,p----Stk� A. ;------------- ' Owner's Name--------Mr-e--- Si��?- 'S• J08 -----------=---------------------`'=--------------------- ,� t ._.. r # ----------------- Phone------ - ---- ---•--• , Address__'--. 1133 S�. rrY...Rd. Stki nth =C ` - `` -----------------------•--------------..__.. ' Contractors Name- ?_ala-- ePtc---dank-_9e__rvtae,---.Inc. Phone----$0a----3"' �2"� Installation will serve: •Residence Apartment House E Commercial -Trailer Court ❑ Motel ❑ Other ❑ Number of living units: :- '-__ Number of bedrooms __a_.. Number of baths -----_ Lot size __1 0-_X- 100_ Water Supply: Public,sysfem,.(2..,.,C ommunity system-C] Private [❑ Depth tb'-W ter`Table--4-3--ff.— Character -4-3--ff"`Character of soil to a depth of 3 feet: - Sand ❑' Gravel ❑ Salndy Loam E] k ClayiLoam ❑ Clay ❑ Adobe X] Hardpan C] Previous Application Made: Yes ❑ No ® New Construction,; Yes Ejt No E] IFHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: 1 i (No septic f" A or'cesspool permitted if public sewer is available within 200 feet.] , Septic"Tank: Distance from-nearest well----------------Distances from foundation--.-I-_---_-----__.Material.-_-__..------------------ ---._._-.------.-.----.-. Exist'iag 'INo. of compartrnents------- ------------------Size-------€----------- ------.- Liquid depth-------;`' CapacifY Disposal Field: Distance from nearest well-------- -------Distance from foundation -__---------------_.Distance to nearest lot line------------ Existidg• Number of lines--------------------------------- Length of each line-------------- --------------Width of french----------------------------------- iType of filter material--------------------------Depth of filter material----------------------Total .length-------------------.---------------------- L -----__---_--------- Seepage Pit: 'Distance to nearest well_----.IQ..-.----}Distance from f undetion---____ - gyp--A_..Distance to nearest lot line_��1e-_ >Number of pifs.-.-.._.1----------Lining material_i9hk__-E----.Size: Diameter---2aP-----------.Depth-----3A"'f t,----------- Cesspool: Distance f3 om nearest well----------------Distance from foundation----;--------- -- Lining material------------------------------------- Vl --------------------- - ---------- -- l ❑ - Size: Diameter-- --------=-----Depth �-k �--- -----------------------------Liquid Capacity----------------------------gals. Privy: ..Distance from nearest well---------------------_--.- 1__Distance from nearest building.----..---.-_--------.----.--------------. ❑ Distance to nearest lot line - "----'- -------=----- - _— _. ----- --------------- -= _ = = = Remodeling and/or, repairing {describe---------------addi.n rock—filled see � it �,� exietin * ----- -------------........... .......•--- F P •------------- �---------------- ----------------------------- --------------- 1i8 --------------Yf_------ •------=-------: .� t k ---=------------- ----------•------------------------------------•--•---••------------------------ --------------------•--------------- ---------------- --------------------------------------------------- -------------'-•-----------=----------------------------------------------------- ------------------•------------ ------------------- - - --------------------------- -I•-------- -- ----- -------------- ------ - -------------------------------------------------------------------------- I hereby certify that'll have-pPeparecl-this-application and`fhat"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 1.. 1 (Signed) , -'-Delta -B tic Tank-�S�sY'viCe:-.Inc• -------------------------------------------------Owner and or Contractor P-eP Tarthan.:-.:. --= - ------------------------------------------------------ --- Title G---en.- Mgrs _----------- ---=---------------- Y:----- 'Y`. y ' { 1 (Plot plan, showing size of lot, location of system�in'relation to wells, buildings, efc., can be placed on reverse side). I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------}------------- ------------- = --------------- DATE----------------------- ------- -- REVIEWEDBY----------------------------------------------- ---------------------------------------------------- DATE----------•---- 119------------------------------------- BUILDINGPERMIT ISSUED------------------------------ ----- ----------...-.-_-----------=-------------------------- DATE------------- -------------- -------------------------- . Alterationsand/or recommendations----------------------------------- -----------------------------------------------------------------•------ -------------------------------------- - ------ ----------------------- lQ "! -'--7----------rJ!� Tt�-------�,C uhf --------' T ----------- -------- -------- -------------------------= --- ---------------------------------------- = �' �a �' � . .- V, --------------------------- ----------------------------- - F ------------------------------•-----------------------------=--------- ----------------------------------------------------• - d FINAL INSPECTION BY:.--- 1✓"�: -" - �. .. . Date �Q -� ------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M , Revised 5-57 F.P,CO.