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----- ----FOR OFFICE USE:- - -- - -- -- � 071 --- - ---- -- - - -- - - - - -- '� APPLICATION FOR SANITATION PERMIT Permit No. . ---------------- ------------------:----------------- --------------_------------------------------------ ------ ------ --- (Complete in Duplicate) a�/ This Permit Expires 1 Y ear From Date Issued Date Issued - ----------------- Application is hereby made to the San Joaquin Local Heal+h District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 5`49 JOB ADDRESS ANDD LOCATIO�JN.::Z7_. . 4/A_7—.l s..t_ t � 1.7 "'--------------------------- Owner's Name--'-�#-o#AoB------4---- -4x1% L �----------------------------- - --------------------------------- ...... Phone.-------------------------------- Address +D _ Q :•►--- -�i /� -� I E---------•----.------ - Contractor's Name--- L ' _ c._ Il?'�i� ..-__-. Phona_�'��- Installation will serve: Residence [! ""Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: I--- Number of bedrooms '_- Num of baths -I-.._ Lot size ___L__��/r��........_______________________ Water Supply: Public system ❑ Community system ❑ Private Depth to W r able -6.- ft. Character of soil to a depth of 3 fee+: Sand Gravel ❑ Sandy Loam ❑ lay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: [If yes,date------------------_l No New Con s+ coon: Yes ❑ No 5EIr FHA/VA: Yes RT"' No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if LLpublic sewer is available within 200 feet.) '00of Septic Tank: Distance from nearest we �__-_____-Dis#ariq f�� d�tio _�___ -.-.---- Material. _ ----_--__ ur` No. of compartments_..---------------Siz /s ._ _.___Liquid d i th_ ._._....-.----.-Capacit Q--(- Disposal Field: Distance from nearest well, -_.---Distance from foundation��___._.-_Distance to nearest lot line---.____ ❑ Number of lines-------------��.�,,,,�•�-------__ _______ Length of eachline-- -- ---- _.Width of trenchm_ ___#'_____.._____.. Type of filter materiaLlb l / __Depth of filter material_ _f�________Total length--------Q-----__.- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line--_---------_-_-_ ❑ Number of pits----------------------Lining material----------------------.Size: Diameter------------------.----Depth--------------------------------- Cesspool: Distance from nearest well_________________Distance from foundation....................Lining material___-__-..__-___-_________--_.-___---_. ❑ Size: Diameter----- --------------- ----------------Depth---------------------------------------------------Liquid Capacity---------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------- ElDistance to nearest lot line----------------------------------- -------------------------------------------------------------------------------------------------------- Remodelin and o re airin de tribe):_ ........ - ------------- � ------------------------------------------ - ----- :� -- - ---- ------- I hereby certify that I have prepare his application and tFiat the work will a donein accord - ant with San Joaquin County ordinances, St fe laws, and rules and regulations of the San Joaquin Local Health District. (Signed) - - -- �--- q __ ------------ (O_wner nd or Contraco --------------------------------_ -----------------------__ By• Title ------------------ --- ---------- -- z -------------------------------------------------------------------•----------- ( (Plot plan, showing size of ot, of system in relation to wells, buildings, etc., can be plat on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- ---------------------------------------------------------------------- DATE------ -- -------------- REVIEWEDBY-------------------------------- -------- - ------ --------- ------ --- -------------------------------- ------------------ DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED-------------_---------------------------------- --------------------------------------------------- DATE----------------------------- ---------- -------------------- Alterations --------------------- - Aiterations and/or recommendations-----------------------------------------------------------------------------------------------•----------------------•---------------------------------------- FINAL INSPEC BY: Date--- - -------- 1_- - „--------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.F.0 O.