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FOR OFFICE USE: Permit No. _c��.�-�r�-`•-� r {v `� APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) I, - ---- -- --- ----- ----- Date Issued ------ - - . �Q-- --- ---- ----- --------- This Permit Expires 1 Year From Date Issued ----------- ----- ---- -- App lication is hereby made to the San Joaquin Local HeatDist for o a permit to construct and install the work herein described. This application is mad -;n — fiance with County Ordinance ------------------------ JOB ADDRESS ANQ LOCAT)P --- 5 � dfl1._� Ph ?.c�!_C,�� one --- Owner's Name --- Address-------- - 4 f _ !r/ .. f-� CL-C.; 6 Phone- �4--._� Contractor's Name------------ i ---------- "_t-- Motel ❑ Other ❑ Installation will serve: Residence Apartment House C1 Commercial Trailer Court ❑ Number of living units: __ ----- Number of bedrooms _-..._--Number of baths�__.._.- of size --- -- ------- - Private ❑ Depth to Water Table l-0 - ft Water Supply: Public system Community system ❑ Adobe Hardpan ❑ sail +o i depth of 3 feet, Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay Cl No Character of P VA: Yes ❑ Previous Application Made: (If yes,date-------- 1 No %_ New Construction: Yes No ❑ FHA/ e TYPE OF INSTALLATION AND SPECIFICATIONS: K F. [No septic tank or cesspool permitted if public sewer is available within 200 feet.} I tAc�' ��----- • - .Material _��i!E= �- ---- •-- Distance from foundation-S70 - I Distance from nearest well_ IJLL -- �r Ca acifi � � � Septic Tank: 1 -------- No. p y I No. of compartments_.. C,�---J-�----- -- Size___f-�--�--��-�----•Liquid depth_. - -- --- --- - � l �---___-._.Distance to nearest lot line---- --- Disposal --- - Disposal Field: Distance from nearest well./ VC-. Distance of re each line-_60-om e- Width of trench_-1 ----- ---------------- (, �y( Number of fines _ ` Total length -... _._- ----•---------- • �"'�____De th of filter material__-(--- - ----� --- g � Type of filter material__._- p Distance to nearest lot line_ ' ------- J�'- %!d• --- - I. Seepage Pit: Distance to nearest well_/L�.QL_----- Distance om un Size n�iameter___�-�-j�-- ----Depth._ �--------- .pa Number of pits..-�- ------Lining material__ ___________ Y� Distance fiom nearest well __-.__-- .----Depthce from foundation:_-----:--_: :Liquid Capacity-__________-------------gals. Cesspool: I ❑ Size: Diameter_ __ -._____. - Distance from nearest building--------------------------------- --- --- Privy: Distance from nearest weil------ ----------------- ----- - C ----------------------- \, ❑ Distance to nearest lot in 2 \ Remodeling and/or repairing (describe): __ ----------------------------------------------------------------------_ ------------------- -- i --- ---•---------------------------------------------------- i ---------------------------- -------------- ---------- ------------1:------------------ and that- I hereby certify t!1 a preparedu�ations off tt� San Joaquin hLocal kHealth eDi tnc}n accordance with San Joaquin Coun y ordinances, State law , and r es and g l s (Owner and/or Contractor) .._. ._ -- ---- - ----------- Si ned ---- - { 9 ) ------ LTi+le) - By:------------------ ---- --- - (plot plan, showing ze of lot, location of system in elation to wells, buildings, etc., can be plat on reverse side).. FOR DEPARTMENT USE ONLY DATE..1 ___ _ _: -------------------- -- ---------------- APPLICATION ACCEPTED ii ---- --- - F - .�..� ,� - - ------- ------ ------ --- ----- DATE-- - ------- -- ------------ ------------------- --------- ----------------- ---- -- - ----------------------------- ------- REV1>=WED BY---------------------=-------- ------ D'°` ------ :------- --------------------- --- ----------- i --------------------------- --------------- BUILDING PERMIT ISSUED.--------- --------------------- ----- Alterations and/or recommendations:--- -------------- - t -- ----------- --------- ------------------------------ ------- ------------__...._. Date._._-"'" 2_4,,4--?- ----- --- --- ------- ------------- FINAL INSPECTION BY:Xov_ _-- - - SAN JOAQUIN LOCAL HEALTH DISTRICT 124 Sycamore Street 20.5 west 9th street 1401 E.Hazelton Ave. 300 West Oak Street • Jodi, California Manteca,California Tracy,California Stockton,California E.H.9 2M 1-67 Vanguard Press -