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------------------------------ <br /> r <br /> ------------- "' . <br /> --------------------- <br /> - — APPLICATION FOR SANITATION PERMIT 1 G 3 <br /> No. -•---•-•----. <br /> . . (Complete in Duplicate) <br /> This Aermit Ex fres t Year From Date Issued Date Is <br /> ml <br /> Sued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct <br /> Thi ap lication is made in compliance with County Ordinance No. 549. <br /> £[ � ork <br /> ;E An0_1 t shall the work herein described. <br /> JOB ADDRESS AND LOCATION___jl�t <br /> Owner's Named-dam. <br /> "_•_. - <br /> Address --------•----- ---- -------------------------------- Ph <br /> C one <br /> .=- �.�— J -------------------------- <br /> Contractor's Nam er� ----------- ------ -r - <br /> ,/ ----- <br /> . �� - <br /> Installation will serve: Residence <br /> -,�.�..---- w -----:- P'hon'e._ <br /> Apartment House <br /> ❑ Commercial ---------------- <br /> Number <br /> of living units: .__ ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> _ Number of bedrooms _3-_- Number of baths _____ Lot size <br /> Water Supply: Public system <br /> ❑ Community � - ' <br /> system ------------- <br /> Character of soil to a depth of 3 feel: Sand Private Depth to Water Table ft. <br /> ❑ Gravel [] Sandy'Loam.El Gay Loam ❑ Clay <br /> Previous Application Made: (If yes,date-------------- <br /> El Adobe <br /> 1 No Da New Construcfion: Yes [I Hardpan ❑ <br /> TYPE'OF INSTALLATION AND SPECIFICATIONS: _ ® No ❑ FHA/VA: Yes ❑ No ❑ <br /> (No septic tank or cesspool permitted if public sewer is available within 200of et.) <br /> Septic Tank: Dis <br /> Eltance from nearest well----------------- <br /> Distance from foundation__- <br /> No, of compartments ----------------Material ------ <br /> _ _ <br /> Disposal Field: Distance from nearest well..- 0'-- Distance from foundation depth--------------------------- <br /> Capacity------------- <br /> Number of lines-- -n -------------Distance to nearest lot line-_vS_" <br /> -- --------Length of each line---------t1 ' <br /> Type of filter material _ -__ • - ------------Width of french___--�- _ e' <br /> epth of filter material--__ _9 'r B ------------------•-- (0 <br /> Seepage Pit: Distance to nearest w of <br /> __Distance from foundation_:____.___ .-- <br /> t <br /> �...� Total length_-----'-�--_-, <br /> � Number of pits--------------- -,_Distance to nearest lot line <br /> ---.---Lining material--------------__-- -.-Size: ---- <br /> _ - <br /> rep <br /> ----------------- <br /> Cesspool: Distance from nearest -------- --------- <br /> from foundation-------------------Lining materDiapth. <br /> ❑ Size`. Diameter_________ ______ <br /> ---- ----- ----Depth------- ------------------------ p y <br /> Privy: Liquid Capacity---------'------ <br /> Distance from nearest welL - ------------gals. <br /> Distance from nearest building Distance to nearest lot line________ ____ ___ A ' <br /> ------------------------------------------------------------------- ---- <br /> emodeling and/or repairing (describe):__----- - <br /> _ - <br /> ------ <br /> i <br /> ----------- <br /> ---------------------------------- -------------- <br /> - ------------ -------------------- <br /> --------------------------------------•--------- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San J <br /> --- - --- - -• --- - -- -- __ <br /> --- ---------- ----------------------- <br /> ordinances, Sfafe laws, and rules and regulations of the San Joaquin Local Health District. <br /> ------------ <br /> oaquin County <br /> (Signed ' �w <br /> BY•--- _ . f ----- --------------------- or Contractor) <br /> - ; ---------- --------------------------------------- {Owner and <br /> ( Pg (Titlap — --- - ---- - <br /> Plot Ian, showtn size of lot, location:of system in relation to wells, buildings, etc., can be laced on reverse side. , <br /> . g <br /> FOR DEPARTMENT U5E ONLY <br /> APPLICATION ACCEPTED BY----- <br /> � - -', <br /> REVIEWED BY-------------- ------------------------------------------- DATE.. -/--li <br /> UILDING PERMIT ISSUED-------•---_-- -- -- ----"---- <br /> - ATE----�------••---�--------=----- <br /> ---------------- <br /> --------------------- ------ <br /> erations and/or recommendations:. - DATE <br /> I <br /> -•-----•------------------- <br /> ------------------------------------ <br /> FINAL INSPECTION BY ,y� <br /> Date_ ICL_ 3 <br /> - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1641 E.Ho:elton Ave. <br /> 300 West Oak Street <br /> Stockton,California Lodi,California ?24 Sycamore Street 205 West 9+h Street <br /> Manteca, California <br /> ES 4 REVISED 0--%9 3M 3-'63 F.p,CO. Tracy, California <br />