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FOR OFFICE USE: ---------- APPLICATION FOR SANITATION PERMIT Permit No. .10_'1?_T_e� -------------- - -------- -------- y .'_ - -- ---- - (Complete in Duplicate) Date Issued ---' This permit Expires-4---ear-From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and in' all the work herein described. This application is made in compliance with County Ordinance No. 54 . JOB ADDRESS AND L ATION.....�_24 r',--- ----------------------------------r-------- Owner's Name----------------- ----- ---x`•---------- �---- -- ------- ----I--------------------- ------------------- ------- - Phone------------------------------------ Address------------------------ 3 '-------- ---- ------ -----�-- ------------------1-1 -- -----------•------ ------------------•- Contractor's Name ".a.� ----- Phone-------- •------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/_ Number of bedrooms ---/'Number of baths_/-._ Lot size Water Supply: Public systemCommunity system [ Private E]Private to Water Table ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ] Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan E] Previous Application Made: (if yes,-date---------........ .. ) No ❑ = New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) t F �pt' ank: Distance from nearest well-----------------Distance from foundation--.---___-__.__-.-..Material __----.._-.---_------__-.__. No. of compartments---------- - ------------Size-------------- ----- ----- -:---Liquid depth--------- ----- Capacity.... I Disposal Ftesld: Distance from nearest well Distance from foundation__ ____.__.Distance to nearest lot lin e._________. / �A Number of lines__.--! ____.____..__ ____-Length of each line--. _ 1�____..._��...Width of trench.... r� .____.___�-.�.. Type of fitter materiaL_w+�ore"Ie Depth of filter material__. _� Total length_______________________'�___ --_--_-.- , ,�♦ „ v Seepage Pit: Distance to nearest wellR Distance from to ndation- tee ------Distan,;.e to nearest lot line_ . * IN Number of pits.-- --/--------- g P �, - - - Dep45�th- o Linin material _.. . Size: Diameter_ _ ._. - De th____ ________________ Cesspool: Distance from nearest well ----------------Distance from foundation.,. ------------- --Lining material-.-....__---_.____-_---:._-_-_--.,. ❑ Size: Diameter- -------- ----- --- Depth------- ------- ----- -------------- ------------ Liquid Capacity----------------------------gals. Priv Distance from nearest well__.____.. ..........................:....Distance from nearest building_---------.__---.__-.-_____--__-.-. - -- y: - ❑ - Distance to nearest lot line-------""......==�'- ----------------- ------------------------ -•--• ------------------------------- - ----------------------------- k ------------------------ Remodelingand/or repairing (describe):------ ----------------------------- - -----------=--------------------------------------------•------------------------------------------------ ----------- - -----------------------•------------------•--------------------------------------------------------------- --------------------------------------------- -------------------- 4 ---------------------------------------------------------------------------------------.._..---------•-------------------------------------------------------------------------------------------------------- I hereby certify that I have )pared this application and-that the work will be done,in accordance with San Joaquin County ordinances, ate laws, and rule and ulations of the San Joaquin Local Health District. ` (Signed} KIC `. --------- - O e nd/or Coatractorl '� . By:---------------------------- ---------- ---- ---------------(Title) . (Plot plan, showing size of lot, location of cyst in relation to wells, buildings, etc., can be p ced on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .Q r0 x r-- ---�?_- - ------------------------ ------ DATE......,<f-1 / '= ---------------------- REVIEWED BY-------------------------------- F ----------------- DATE--------- BUILDING PERMIT ISSUED-------- -- -- ': - - DATE--------------------------------- - ------------------------- F Alterationsand/or recommendations:--------------.. ------_---------------- ---------•--------------------------- ------------- --- -- --F-------------------------------------------------- f ------------------------------------------------------- --- --- -- ------ --------------------- ----------------------------- ---------- ---•--------- ---------•- ------------------------------------- -------- ------ - - -- --- -----...... ----------- -------------------------------------- --------- -------------- .... -------- -------- ---- .. .. FINAL INSPECTION BY: Date_ ------.._/---_r-.----!__----� --- -- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street 5lockton,California Lodi. California Mantecar California Tracy,California E.H.9 2M 1-67 Vanguard Press