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# FOR OFFICE USE: . M -------------------------- ------------------------------ APPLICATION FOR SANITATION PERMIT Permit No. fJ_L,3. ---------------------------------------``------ ---- --- (Complc�,e in.D.Rplicete) Date Issued ---_lc -------------- This Permit Expires 1 Year From Date Issued - Application is hereby made to the San Joaquin Local Health District for permit to cq�1s#rust in a work herein described. This application is made incompAZ,�T h County Ordinance No. 54 �q�Q jM� o -e JOB ADDRESS AND, C- ATION--- rLQR: .-,., D._:l�lwr:, '------ \ --------------------------=--•------------ Owner s Name--------------n-` EFO_��"--'------ - � ---------- - ---- -:----------------- ----- -- ---- Phone------------•- ----------•- •-------- ES -----=--=-- - = _ =.. - Address------------------------ ---- / _Contractor's --------------------------------- = .._ ------- -------- Phone --------- _Intallaton t will serve:-Residence ❑ .Apartment House ❑ Commercial ❑ Tra iler:!'J e t [+ff"'Mo#el ❑ Other El Number of living units: ---(--- Number of bedrooms -Number of baths. t-"''.Lot'size _AC__KEJ6_�--.- --- Water,Supply: PublicsystemE] Cammunity system E] Private epth to-,Water Table ./57-ft. t Ilk , 4 Character of soil to a'depth of 3ffee+c Sand Gravel ElSandy Loam 0 ` Clay-Loam ❑ Clay ElAdobe❑ Hardpan ❑ Previous Application Made: (If yes,date----------- -------1 No. New Construction: ,Yes'��o E] FHA/VA: Yes ❑ NoR___, - -TYPE OF INSTALLATION AND SPj CIFICATIONS:=- ----��-- ' '- . --■ '" ` - ' ' - = `� - (No septic tank or cesspool permitted if public sewer is available within 200 feet.) -" Septic Tank: Distance from nearest well ----Distance from foundation-_--/0---.--..Material-----COr�cR�-7-�---. /a -'th---�l- Z--------Capacity--- `+-0---------- � p 9 q No. of com artments-.--�-___-_-_.---.Size_.��____X_-�___-,_._Li ui Disposal F' id: Distance from nearest, well--- __0 Distance from foundation---._. -----.Distance to nearest lot line�-_._5��--- �� ----1-----Width of trench-------- ��----------------- Number of lines--- -------_I-_----------------Length of each line----___ - Type of filter material-_- 0�1.--Depth of filter material------- --i�--__Total length------- -------------•___---._ Seepage Pit: Distance to nearest well----------------------Distance from foundation---------------------Distance to nearest lot line----------------- ❑ *,-Number of pits---- -----------------Lining material-----------------------SizOOiameter--------------.--------Depth--------------------------------- V t Cesspool: Distance from nearest well..---_.__--_.-_ -- Distance from foundation ------------------Lining material-------------.-.--------.---_-_----.. �► 11� [] Size: Diameter----- - ------Depth--------------------------------------------------- Liquid Capacity---------------------- Privy' Distance from nearest well---------------__---_-.------.----.-._------.._Distance from nearest building_-_____-___- __------_-------..--------- ❑ Distance to nearest lot line- ------------------------------- --------•------------ ------------------------------------•------------------------------------------- g l Remodeling and/or repairing (describe):-------------------------------------------- - ------------r------------------ �,. ------------ I I --------I hereby --emit---that I have-PT--Pa-----------------------------------------------------------------------=------•------------------------------------------------=---------------------- ------ d I y y fired +his application and that the work will`be done in accorJance with San Joaquin County ordinances, State laws, and rules and+regulations of the San Joaquin Local Health:District. (Signed) _ ---------- -` ---=----- ---- ----- ----- -(Owner and/or Contractor) yr r ..a..�. .. ..�. +--- (Title) _ =t� �..� _ii3y::.: s �- (Plot plan,_'showing size �f let, • of system in relation to wells, buildings, etc.,'can be placed on'reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- C7---------- --------------------------------------------- DATE--------- ---------------------- REVIEWED BY----------------------------------- --- --------------------------------------- -------------------------------- -'-_---- DATE------------- ---------- - - BUILDINGPERMIT ISSUED--------------------------------------------------------------------------=------------------------ DATE------------------------------------------------------------- Alterations and/or recommendations:------------------ --- --------- -------------------•-------------• ---------------------•-- •------------------- -------------------•----------- -------- ----- a-- FINAL INSPECTI BY:. ------ -- --- ----- Date------------------- A r ------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street stockton,California Lodi,California Manteca,California Tracy,California F.P.CC.