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FOR OFFICE USE: �\� �d '\L/-------------------- ------ APPLICATION FOk SANITATION PERMIT Permit No. 021 -------------- - - - - -------- (Complete_ in Duplicate) This Pyrmit Expires 1 Year From Date Issued Date 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 AN LOCATIO ___kl�_.-__B_ YlYl1/�O __!? --- � 1 •- ----------------------------- Owner's Name-----JQ.l----�lgad-0-BL �A' ,l 't-N'�/ Phone__ A Address ' '- .JC�.Ik-------•�7- 4,0 ....-----.. ........................................................... Contractor's Name...-- - f-�. 1,S,f S'�_.�tY----------- Phone_9-04_ ,6.0?__..... Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ----j__ Number of bedrooms -4- Nui'm: ber of baths _._ Lot size ___ 7---- `, __O-' ____---------- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table _1-s fti Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [Clay [ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date----..--- --------- ) No [.[ New Construction: Yes [No ❑ FHA/VA: Yes [fir 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.t�------------.Material_ _va-,a'�.57-- -_ Z / No. of com artments.... .--_ Size_ J �J' p ----- �l�X_�P: Liquid depth__,��_`f ---Capacity��,�d-_�IP,C Disposal field: Distance from nearest well--- _.._Distance from-foundation_/. ........Distance to nearest lot line__ ___..__. lAo Number of lines----,3-------- ________________Length of eacholine_ '`` g /.�_��4Q__.Width of trench__ ._. Type of filter material __�__De th of filter materia1--le__ ______Total length_._ P � -------------------- See�pag/e Pit: Distance to nearest'we L`1�Q_._.__._Distance frjtm foundation___/0___..___.Distance to nearest lot line__.5....__ Number of pits-._-.,�__ ---____Lining mate ria l_S'ApAx-_.Size: Diameter_-5.3_--_-__-.Depth-__,��i ."_____________ Cesspool: Distance from nearest well----------------- from'roundation--------------------Lining material-__.__.-__.-_------__._-..___-- ❑ Size: Diameter----- --------------- ----------------Depth--------------------------------------------------.Liquid'Capacity---------•--------------_--gals. Privy: Distance from nearest"well ____ '.... . ............. . .___._.. .-Distance from nearest building-------------- ---___--_--❑ Distance to nearest lot line_____ :............... Remodeling and/or repairing (describe):-----/ ------- x'`+5--27 7;� -------------------------------------------------------------- --------------•-------------•---------------------------------------------•---•---- -------------------------•---------------------------- - 1 hereby certify that I have pre ared this a plication and that the work be done in accordance with San Joaquin County ordinances, S�f , rales re ions of the San Joaquin Loca ealth District. (Signed) ; 1 _�� .--- ----- ��! _ N C------ n and/or Contractor) so By:---------- �i � .��i -fir'--------------------------------------------- -----------(Title)-- '------------ --- ---- --------- (Plot plan, showinglot, locf system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------- ---- ---------------------------------------- DATE_----------y1/1b_.. REVIEWEDBY--------------------------------- -----------------------------------------------------------•------- ---------------------- DATE----------------------_ ;- BUILDING PERMIT ISSUED-------------------------------------------------------------------------------- ------ DATE Alterations and/or recommendations:---------------------------------------------- ------•-•------- ------------------------- -------•-_-------------- -----•-------- -------------------------------------•---------------------- -•-----•---------•-------------------------------•-------------------- ---------------------------•------------------------------------------------------------ -------..----------- ------------------------------•--------------• ------------ -------•------------------•-- ---------------------------------------------- ---------- ------------------- ----------------------------------------------.-.------------------------- ----------------------•---_----_-------------- -••-----------------------------•------------- -------------------- --------•------- ---------------- ------ ----------- ---------•-------------- ------------- ------------- FINAL INSPECTION BY:------ -- ------------------ --- ------ - Date-------------------- s/G6 --- ------ --------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California