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FOR OFFICE USE: --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ........ ----------- ------ (Complete in Duplicate) --------------------- -------•------- --- This Permit Expires 1 Year From Date Issued Date Issued'-__14"/1__6.7 cal Health District for a permit to constructand nstahthe/work cherei�/described. Application:is hereby made to the San Joaquin Lo This application is made in compliance with County Ordinance No. 549.,_,40C&j20R,0 JOB ADDRESS AND'LOCATION_ � Akp, X------------------- ----- ��j-- Owner's•.Name-----•�Ael------A�P.1W..AY_J`-,R 77 ,. _ R """' _.. ---------- Phone.................................. Address-------•- `----�O.Y-lp�7 42 .�.�° .. _ -••---------------•---------------------------------------•--•-- Contractor's Name �_ � � 's.�P�,S-------- ---------------------------------------------------- PhoneQES, �QZ Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer -6eatst [.!r Motel ❑ Other ❑ Number of living units: _/-__°Number of bedrooms _/-___ Number of baths __/___ Lot size ___ elcAeit ,------------- Water Supply: Public system ❑ Community system ❑ Private [Depth to Water Table ________ ft. _ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam V Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------I No t!f New Construction: Yes No El FHA A: Yes No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: '"' Distance from nearest well_='0-C'_-_Disf ce from foundation _______.---.Material-_'/ ® No. of compartments_______-..Z-------------Size_-s�",,---- 24--------Liquid depth_-_..'}� �.�i Capacity- -_..... G Disposal Field: Distance from nearest weN_b:dG-'.--Distance from foundation.__-?!��_,.._.Distance to nearest lot line__ie�.-:. b Number of lines-------------- -------------------Length of each line----------60_t - __-- ---•--Width of trench.-------.. haf-'-'�-�• ---------••-- Type of filter material._.t'%__0K--------Depth of filter material____.f_ y Total length- ---------------........... Seepage Pit Distance to nearest well-----_----------------Distance from foundation--------------------Distance to nearest lot line................. a ElNumber of pits----------------------Lining material----------- -----------Size: Diameter-----------------------Depth---------- ------ Cesspool: Distance from nearest well-----------------Distance from foundation---.____...._____-Lining material_________..-_-____-___------------- El Slze: Diameter. Depth �-`--" -----------------------------------Liquid Capacity -----------gals. Priv _' ----Distance from nearest building----------•---------•-------•-----.......... �t ❑ Distance to nearest lot line -------------- •-------------------- z4_Remodeling and/or repairing (describe):__--___. #1 Ze-P Q�.c�_{� fi'o f P •-- T ' -------------------- - ----------•---------•-----•-•---•-----!------ - •-•- - -------------------------•------------------•................................... -----•--------- -------•------•-------- ! I hereby certify that I have prepared this application and that 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) = � _ �. r '. _1 si f sf BN.. ..f/1G `-------------------------------------------------•--.-----(Owner and/or Contractor) s : --- ----- ------ - ------ - ----c_ _ -- rifle}------------------•------------- (Plot plan, showing size of lot, locat n of system in relation to wells, buildings, efc., can I e'placed on reverse aside}. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED -- -- ---------------------------------------••-------------- - DATE...L _-1 -- , ,RE VIEWED BY -------------------------------------- ----- ----- DATE------------- BUILDING PERMIT ISSUED..-------------------------------- ------•-----------------••----------- DATE........ Alterations and/or recommendations:----------------------------- t -----•-------------------------------- 1 -------- ----------------------------------------------------------------- ------------------------ ---------------------------------------------------------------------------------------------------------------------------I------------------------------------------------------------------ ---------------------------------------------------------------- -----------------------•---- - --- -------------------•-------------_-------------------------- ----------------•-------••-------- --------------------- FINAL ----__-FINAL INSPECTION BY:- � - ~: Date _ - "�/ 2 .. { ---••-- �. . SAN JOAQUIN LOCAL HEALTH DISTRICT Q;4 - 130 South American Street 300 West Oak Srreet 124 Sycamore Street 205 Wast 9Th Street Stockton,California Lodi,California Manteca,California Tracy,California EB 9 REVISED 8-59 2M 5-61 ATLAS