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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----------- 810-__Eaet--Market__8treet--------------------------------------------------------------------------------------- Owner's Name-------------------------------------------8;08-------Ramos--------------------------------------------------------------------------- Phone---------oAp- Address________________________________ 2810 East Market Street ---------------------------------------------------------------------------------------------------- Contractor's Name--•----•-•---•------------- - D� & 9-_960?-------------- -�---P�RRISH-- -----SU>�33�_._�MC�---- ----�---------�------._. Phone_------ - - Installation will serve: Residence [][�-Apartmenf House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ; I � Number of living units: �] Number of bedrooms (3 Number of baths [I Lot size____ _ _1 i-_---�--1�•Q__------------------------------ ` �► i 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: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) —` Septic Tank: Distance from nearest wellNQA _-___Disfance from foundation___10-I_______-Matenal._Ur9;!!C0A0—B-3—X.------ No. of compartments---------2_____________Capacity--9Q©--d____-_Siz - 7C�______.x --Liquid depth._-___5 � deep Oirc Cesspool: Distance from nearest well----------_-_-_-Distance from foundation--------------------Lining material------------------------.-.--_--.---_-. �] Size: Diameter------------------------------------- Depth----•----------------------------------------------- _ ___-----Distance from nearest building Privy: Distance from nearest well------------------------------•--------- g-------------------------------------_- ❑ Distance to nearest lot line---------------------------------------- r { Seepage Pit: Distance to nearest well-----NQA!_-----Distance from foundation---U-1--------Distance to nearest lot line____- _---_ ® Number of pits--------1-----------Lining mate rial_91 0`_GOMe: Diameter-_---., 30--____-_-.Depth---2Q------------------------ ) I it Disposal Field: Distance from nearest welli(OnC------,Distance from foundatic, ___128___-_-.-Distance to nearest lot line-111------- ® Number of lines-- - _ ----__-_Length of each line____-_- ----------------Width of trench-_-_--_-Z_4- -_---_ -_---_ _ Type of filter material._ _M__-- C CDepth of filter material___1 N il � Remodeling and/or repairing (describe):----------KeV---=B_1;_83_1 At.J-0I1--------------------------------------------------------------•---------------------------------- I 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. s i (Signed)----- ------*----------!@----------`--------- '----------11!----------k---------------- Contractor) f By:----- } �emin ------------ ..'W. -{Title)----ES7IM,A''OA------------------------- ------ (Plot plans, sh ng size of lot, location of selation to wells, buildings, etc., must be filed with this application). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY----------------------- e - -- ----------------------------------------------- DATE-------- --------=--�----------------------------- REVIEWED BY----------------------------------------------------------------=- - - -- -- -------- - -- -------------------------- • DATE............ --- .-------�-77/----/--------------------------- BUILDING PERMIT ISSUED-------------------------------------------------------- DATE---------------------- --------- Alterations and/or recommendations:-`-------------- --------------------------------------------------- ----------------------------------------------------=------------------- ------------------ I ------•----------------------------•----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- _-- ' �-------•---- 1.1......... --- --------------------------------------------- - --- ----- = _,,fN r 'f"f � ° '�� ------------------------------ --------------------------------------------------------- ------------------------------------------------------------------------------------------------------- PERMIT No.--- '�L- ----------- ISSUED---- -- -!�--- /---------------(Date) FINAL INSPECTION BY:-----�-----------' -- - Date SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California T:5-9-2M 9-50 W=1639 �