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APPLICATION FOR SANITATION PERMIT. Permit No, <br /> (Complete in Duplicate) <br /> Date Issued 1XV <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct annstall the work herein described. <br /> This application is made in compliance wi County Ordinance No. 549. c�ye—oero— af, <br /> -7 <br /> ---------- -------------- <br /> JOB ADDRESS AND LOCATION . ------- <br /> ........ .............. <br /> Owner's Name..-0) ..... .... <br /> .......... ........... ......... ......................... ...... �one................ .................. <br /> Address----------61/ <br /> Contractor's Name..___.__ <br /> ------------------------ <br /> ...................... ------------ ...... <br /> �7 ­­­---------------------In----!............. Phone,,;,.... <br /> Installation will serve: R i ;&I <br /> Apartment House E] Commercial 171 Trailer C <br /> ourf 11 Motel El. Othe r <br /> Number of living units:2-'3Number of bedrooms �._&mber of baths _1... Lot size ...... <br /> Water Supply: Public' system 0Commurfi-Fy system E] Private K Depth to Water Tabljo.. ft. <br /> Character of sail to a Idepth of 3 feet: Sand El Ga,,.IA Sandy Loam D( <br /> Clay Loam 0 Clay El Adobe Hardpan E] <br /> Previous Application Me'de: Yes El No X New Construction: Yes E] No k' FHA,/VA- Yes El No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: - <br /> . (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well---.............Distance from foundation....... ............Material <br /> El No. of c6mpartments.__.,----------.......Si2e.........................••-....Liquid depth----------- ----------.---Capacity......................... <br /> Disposal Field: Distance from nearest well..................Distance from foundation.............------Distance to nearest lot line.....__......._.. <br /> Number of lines-----------------------------------Length of each line.................___....Width of french <br /> Type of filter material........................Depth of filter material..........__......Total length............................................ <br /> Seepage Pit: Distance to nearest well......................Distance from foundation....................Distance to nearest )of fine_.._...._ __ <br /> El Number of pits....------------------Lining material.-,.....................Size. Diameter................... <br /> --.-.Depth.-., <br /> Cesspool: Distance from nearest well-_/--_�__Disfance from foundation.....1_2_......Lining maferial..�,�t ....* ------------- <br /> S:ze: r • .. ........... <br /> ------------I......:Depth.....7......................------------­....Liquid Capacity...J1.4-P........gals. <br /> Privy., Distance from nearest well...._...--_.-__.---. -...... ........Distance from nearest b0cling....................­...,............... <br /> 171 -Distance to nearest lot line.............. .........................................------- <br /> Rem( and/or rep , , 21�, <br /> firing escribe),_ / �4 0( 4 <br /> and�or re iring escribe):....=/J�/, ....... ......... . .11 <br /> . ..... ......... <br /> .... .. . ......... . ... ........ <br /> ........:1ill-ro- .......... <br /> ..................I............... . ............................ ............................................................. <br /> ..... ........---------------­---................ ......................... <br /> --­-------------------------........................................................................................ ................................................................... ............ <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin C'.ourify <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signe ...... <br /> ------- . . ...................................... .........•-------- <br /> ---- ................ <br /> ---------(Owner and/or Contractor) <br /> ........7& ----------- ------_-...................---------------(Title)------- ..... --------......... -------- <br /> (Plot plan. showing size of lot, location of system in'talation towells,*buildings. etc., can be 016c on"-reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY. ............. <br /> --- --------------............................................. DATE. <br /> REVIEWED BY...................... <br /> ....................-•-1- . DATE.- <br /> BUILDING PERMIT ISSUED-... ............._...... -- ------ -------------- <br /> . - <br /> .................. DATE.. <br /> ..... ------.......... <br /> Alterations and/or recommendaflons:.................... <br /> .......... ..................................... <br /> .............. ...... <br /> ............... ........... ........ .......... <br /> 7.:�&­r........ ........---------------*--------- <br /> .. ........ <br /> . ........... ....... ...................it............. <br /> ...................................................................... .......___... .. I <br /> I------------------------- .............. .......................................................... <br /> .....................................................:•...... ........ ...... ... .........t. ..........-----............................................................................................... <br /> FINAL INSPECTION BY..... ....... ...... woo <br /> ......... Dat ....... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> Street 300 West Oak Street 132 Sycamore Street 014 North "C"Street <br /> lifornia <br /> Lodi, California Manteca. California Tracy, California <br /> \d 1-57 F.P.CO, <br />