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FOR OFFICE USE: <br />• • ...... ... - • - • ...... • ....... ......... <br />(Signed) <br />-By • <br />I, <br />APPLICATION FOR SANITATION PERMIT <br />'II {Complete in Duplieetel <br />This PerAit Expires 1 Year From Date Issued 1-1 <br />Application is hereby made to the San Joaquin Local Health District for a permit to construct and <br />This application is made in compliance with Coun:y Ordinance No. 549. <br />zq 47../ • _ <br />JOB ADDRESS AND LOCATION__ <br />Permit No, <br /> <br />Date Issued 3 ---4‘ <br />° ( — <br />install the Nidorc -nei..,,,described. <br />•••••••• <br />Phone............. .. <br /> <br />µ . <br />. Phone.............. <br />Owner's Name_. <br />Address <br />Contractor's Name. <br />I <br />Installation will serve: Residenc.e 0 Apartment House 0 Commercial Trailer Court 0 Motel 0 Other 0 <br />Number of living units:17=-- Number of biciroorris=•.-..-Number o t ..2.!.....--Lot size <br />Wafer Supply: Public system 0 Community s0ystem 0 Private Dep ; Table ....... ft. <br />Character of soil to a depth of 3 feet: Sand 0 II Gravel 0 Sandy Loam Clay Loam 0 Clay D Adobe 0 Hardpan 0 .. <br />Previous Application Made: , ;If yes,dote., ... . .:.) No 0 ' New Construction: Yes D No T-1 FHA/VA: Yes r-' No 0 9 <br />TYPE OF INSTALLATION AND SPE-CIFICATIONS: <br />4) . (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br />Septic Tank: Distance fro rn nearest well .„ .... ...Distance from foundation . <br />0 No. of compartments0 Size Liquid depth Matedbi ' C.2apacity_______ ........ ! ; .11. -,--, , ,. , ,.., , Dispo ci: Distance -trora nea-est well se,Y4 t Di stance from foundation ./.t..Distance to nearest lot line <br />Number of lines / e.,IiII Length oi each line Width of trench----/ <br /> <br />. — Type of ,fiter material...,...•eVC_. .. _Depth of :Filter material„ . 4.. . <br />,, <br />. ". ... . , . .Total long& <br />.. , <br />---' ii <br />Distance to nearest well 4 ,Distance from foundation Distance to nearest lot line. ,„ ......... ..... <br />Number of pits' Ilning material ---------------------Size : Diameter Depth <br />Distance from nearest well.] Distance fromio..Indation. :Lining material------. .. - Size: Diameter 1 , Depth . Liquid CePacity gais <br />Distance from rearest well 'J.1! Distance from nearest bu:Iding.„-- ...... -. .... . . __. .... : . <br />.. <br />Distance to nearest lo+ line_ 411 ......... <br />Seepage Pit: <br />0 <br />Cesspool: <br />Privy: <br />. , <br />Remodeling and/or repairir'lq idescribe):. 't‘ <br />• <br />I hereby certify that I have prepared this aPplication and that the work will be done in accordance with San Joaquin County <br />ordinances, Stat s, arid rules and regulations of the San Joaquin Local Health District.— <br />ratr and/or Contractor <br />. (Title). • --` <br />(Plot plan, showing size of lot, location of s'ysten1in relation to wells, buildings, etc..., can be placed on reverse side). <br />IFOR DEPARTMENT USE ONLY 29 41- •- <br /> <br />Alterations and/or recommen4ations: IV <br /> <br /> <br />!I <br />CI <br />II! <br />49.• <br />APPLICATION APPLICATION ACCEPTED BY <br />REVIEWED BY <br />BUILDING PERMIT ISSUED <br />'24,40eir <br />•• 6, • . ••••• • • or• <br />DATE ..f <br />DATE <br />DATE <br />... <br />••• •• • WM.. <br />. MI* •• <br />FINAL INSPECTION BY. <br />1601 E. Hasolfon <br />Stockton, California <br />F P CO. <br />7/1 <br />SAN JOAQUIN LOCAL HEALTKDISTRICT <br />300 Woo 'Oak Street 124 Sycamore Street , <br />Lodi, California Man'teca, California <br />- <br />205 West 91.1, Street <br />Tracy, California <br />Date.