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�-� APPLICATION FOR' SANITATION PERMIT Permit No ._ _�- ___-- Duplicate) i l (Compete n upca Cyt+ Date Issued'' ' 1t-:_� = 10 f 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 incompliance with County Ordinance No. 549. JOBADDRESS AND LOCATION..-----------3,13-4..E t 11arke-t-__ :------------------------------------------------- -------•-•----------------------------------- ------- Phone..3.- 696---------- ------ Owner's Name---------'JQP---�'�.Qy-ee-------------•----•------------------------------------- Address------2226_- .--LW T;t,_ e---------------------------------------------------__°-= - Contractor's Name--------------------------------- DE-I.-a------------------ Phone...- ''3955 Installation will serve: Residence E] Apartment House ❑ Cbrr mercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Cafe Number of livingunits: --._..-- Number of bedrooms _-- kA umber of baths ---1-- Lot size ------.'�5X&.C---------------------------------- --•- -�k. . Water Supply: Public system E2 Community system fl. .;I'rivate ❑ . Depth to Water Table__ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ . Sandy Loam [1 Clay Loam ❑ Clay ❑ Adobe g] Hardpan ❑ Previous Application Made: Yes ❑ No Ej New Construction: Yes ] No ❑ , TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer1ris available within 200 feet.) W Septic Tank: Distance from nearest well----n Aa"Distance from foundation____ .t._._.......Material ----------------------- No. of compartments--------2------=1=.,;---Size---- -1•-X4�-X4-------Liquid depth-----c3_1-&36-------Capacity---$CQ----------- Disposal Field: Distance from nearest well'- '__.Distance from foundation..... .......------Distance-to nearest lot line----------------- ❑ Number of lines-- ----------- "W-Length a of each line------------------------ Width of trench----------------,------------------ Type of filter material------ `------'---__ Depth of filter material------------- --Total length----------------_ ----------------------- Seepage -Fit: Distance to nearest well-__---no-R-'_:__-Distance from foundation-------21-------Distance to nearest lot line---2!....-___- ® Number of pits------1-------------Lining material.==-br__jak----Size: Diameter---------- .._..._.De th----- Cess ool: Distance from nearest well------------------Di: Lining material---------------------------•--------- p Size: Diameter------------------- ----------------Depth------------- ----- - Li uid Ca aci gals. ❑ q Capacity ce� rom foundation Distance Privy: Distance from nearest well-------------------------------------------------- -,e from nearest building-------.------------•--------------------- 1 ❑ -= --------------------•-------------------------------------------------- Distance to nearest lot line--------------------------------------"----- _ ----- T ------------ Remodeling and/or repairing, _____________ -------------------- { ----------- -------------•-------- -- ---------------•------------------------------------- - - -------- -- - -ation -- --------------------------------------------------------------- --------------- --------------- -------------------------------eb certify that I have tapered this application and that the work will b" cco__""" __... ..___an -"aq -"""" n - I hereby y p e done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)-- ------D t .- •-------- --- '-------- (Owner and/or Contractor) --------------------- - (Title)-- �' - - ------------ BY-------•-••----------=•-----------•----1�:rry--`�iar-than--------------------------------------------------------. ��rr�e�-x�Z;�-,-- --------- (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY .ay;. APPLICATION ACCEPTED?BY ------ DATE_ ---------- " DATE-----�----------------------------- ------------------ REVIEWEDBY--------------- *------- -_--. - -----------------=------=--- ---------------------------- BUILDINGPERMIT ISSUED------ ---== ------ - :-------:-----------------------------------------------------••- DATE-------•--T----------------- ---------------------•------ b ....................................................................................................................................... Alterations and/or recommendations:"__:."-_________..-_, � •----------------------------------------------------- -------------------------------------------------------------- ------------------------------------------------------------------------------------------------ _,. --------------- ----------------- ------ ---------------- ------- -- - - - - - - Date- FINAL INSPECTION BY---------------- --'--�---- I SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak S+Fee+ 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 8-51 Revised W-2100