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FOR OFFICE USE: -67 APPLICATION FOR SANITATION PERMIT Permit N6). ------- ---__.___ ' (Complete-in Duplicate) Date Issuedl --- ------------------------- ---------------------_ - - I This Permit Expires 1 Year From Date Issued I Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinanc o. JOB ADDRESS AND CAT ON- _ ------ -- --------- Q -------- Owner's , Name------- -- -- - -- -- - t-om-----}---------- •- --------•-------.. Phone:-----------------------•------ Address----94�_Q---•----cov -- - - ---- / ---------_.. Contractor's Name----------- Installation will serve: Residence R?--*Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -/' Number of bedrooms -c;2-._ Number of baths __/ Lot size ._/4 Water Supply: Public system P--loclommunity system ❑ Private ❑ Depth to Water Table3_5,ft Character of soil to a depth of 3 feet• Sand ❑ Gravel ❑ Sandy Loam ❑..Clay Loam El Clay [I Adobe�rdpan ❑ Previous Application Made: (If yes,date_-- -.--._.-...._.- ) No �ew Construction:' Yes ❑ No L&-1FHA/VA: Yes ❑ No ❑ r TYPE OF INSTALLATION AND SPECIFICATIONS: ; t (No septic tank or cesspool permitted if public sewer is available within 200 feet.) e# a nk: Distance from nearest well_________________Distance from foundation_..___'________-_.Material ----.-.-.--------.__-_---__-__-_--_...___.._. No. of compartments---- ---------------------Size------•-------- -----------Liquid depth__._._._ --- ------- Capacity----------------------- L1V Disposal : Distance from nearest well Distance from foundation-- Distance to nearest lot - - Number of lines.__._____/_....... _ _._Length of each line__.-36-..36 ----------Width Width of trench_____ Type of filter material.__Z_LJY'a_4_C__Depth of filter material__ Q__---------Total length______________________& --------- �\^ Seepage t: Distance fo nearest f m foundation- - Distance to nearest lot Iine-.S--._._.--_. Number of pits.__ ._�_.___.___.__Lining material_ 40 ..... Size: Diameter._ - _1.._.--- r '! ,. Depth_.-. 5 Cesspool: Distance from nearest well .............__Distance from foundation_ +_ __..._ _ Lining material-------------------------------------- El Size: Diameter ---- - ---- ----------- -- Depth---------- .--------------------=-- ---------Liquid Capacity-------------- -------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-------.______--_--___-------.-.-_-_. ❑ Distance to nearest lot line ---------------- ---------------------..,•---------------------------•---------------------------------------------------------------------- Remodeling and/or repairing (clescribe)---------------- ----------------------------------------------------------•------------------=--------- ---------------------------------•----•-------- --------------------------------- ---------- ----------------------------------------------------------------------- ------------------------------------- - --------------------------------------------------------------- I hereby certify that I have prepared this application and4hat the work will be done in accordance with.San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) �_, (Ojwner and/or Contractor) By:-------------------------------------------------------- -- -------- - --------- ----- -- (Title) --------- - ----- ----------------------- (Plot plan, showing size of lot, location of system in relation to ells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY = --- ------ ------------------------------- ---- ------- DATE ' =�7 ---- --------- REVIEWEDBY------------------------------------------ ------------ -- ---- ------- ------- -- ------------------- ------ DATE--- ----- BUILDING PERMIT ISSUED-------- - --------- . _ DATE.------- ----------------- ------------------- --------- and/or recommendations:__..-_ t' .. ,t` �._.�_. _ .__'________._______________________------------------------------------ Alterations ------ ----- - - ------- -- --------- ------ - ----------------------------------- - ---------------------------------------------- ---------------------------------------- S _________________________________________________.___._...._.- ____-..___.------.--_-_.-_ -:-.-----_._____-....__._-___._._...__.__-__..___-______-__....______-__-..--_-__.___._.______.__,-....-._.___-....__._..____._..._ FINAL INSPECTION BY:_--- - -- �_--------- ------------ ---------- Date-- --- 1._r-- - - ----- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi. California Manteca, California Tracy, California E.H.9 2M 1•67 Vanguard Press