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FOR OFFICE USE: _ -------------I------------------------------------------ 1 ___1.;___i_________________________________-_____--.- APPLICATION FOR SANITATION PERMIT Permit No. ...1.��.....�a ----------------------------- -------------------- (Complete in Duplicate) 7 ---- ------ This Permit Ex ires'l Year From Date Issued Date Issued ........� � .,...�.. 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 Ordinance No. 549. 70 JOB ADDRESS AND LOCATION' . = '------------•-••--------------------------• - Owner's Name----------- --AKE. .......... �� LE r, �j _ -------------------•------------------ Phone.................................... Address__. ... ------ -%V&--- QX--- �'' N_ .r ---------------------------------...................................... Contractor's Name---------eW/"Vk_=k.... I ..... Phone................................... Installation will serve: ResidenceApartment House E] Commercial E] Trailer Court ❑ Motel [I Other (jNumber of living units. j.... Number of}bedrooms __ __ Number of baths _1____ Lot size _-_7J�_ ____-J,!55 _________________ .� Water Supply: Publics stem ��y �� y Commune system Private Dep+h TO Water Table _0. ft. _ Character of soil to a depth of 3 feet: Sand-Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan []. Previous Application Made: (If yes,date__-__--__.I_------) No [� New Construction: Yes ❑ No ❑ FHA%VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitteJ.if 4 ublic sewer is available within 200 feet.) ---. , 9 �. 0 .. Septic nk: Distance from nearest well ._ Distance from foundation.--_..!-®_____- at Distance pf . .AD.!�----•---- No. of compartments------ "{'.•_ '::Size ._Liquid depth___-. !-----------Capacity...... QQ_._._ Disposal Field: Distance from nearest well-ISO----Distance from foundation.....I0_______-Distance to nearest lot [1� Number of lines...... __ _I �____-____Length of each line__ Width of trench...____31x---"_______________ iType of filter material._.. G�CYrj,__-_Depth of filter material______l _-__.Total length_____._...-- Seepage Pit: Distance to nearest well_7-----'______-_--__Distance from foundation--------------------Distance to nearest lot ' line----__---- _______-❑ Number of pits.- ._Lining material %- Size: Diameter------------------------Depth-------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material..___-_____-___.___...__.______.-...� ❑ Size: Diameter Depth =------------------`----------Liquid Capacity-----------------•------- gal . --------- ------ Privy: Distance from nearest well'__-___------------___________________-___------Distance from nearest building ❑ Distance to nearest-lot line._.___.____-_�________.__- � �^ Remodeling and/or repairing = - -----•----••------------•-•----•------- --•-•-•----,, �. u ------------• •-•••----------------- •-- --------------------------------------- •------------- --- - _ - ------------,-------• -----------------------------•- --••------------------------------------------ I herebycertifythat I have re ar d this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and r gulations of the San Joaquin Local Health District. -- (Signed).A + ----------------------------------------------••------• -(Owner and/or Contractor} By:------------- ------------------------- ` ---(Title)-------------------------------- (Plot plan, showing size of lot, location,of system_in-relaf;on_+o.w.elIs,_buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------7M R-.0-4----------------------------------------------------.------------- DATE------ ��-� - ----•-------------------- REVIEWEDBY------------------------------------------------------ ----------------------------------------------------•- -•------------ DATE"-•-- ------ BUILDING PERMIT ISSUED--------------••----...------------------------------------------------------------------------------ DATE---------------•------- Alterations and/or,recommend'at ions:---= 1f- -AL-MI;Ti'OAf =ll cx---4 _- ..•--.-•--------------------------------------------•--- ; .. ;.................' t , ,P-...-------•••--•-•-••---••-...._•---------••------............ -- •••-------•-------- y ----------------------------------- - - - ------------------------------------------------------ FINAL INSPECTIOt . ----- Date--------- 1-7- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 Well 9th street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 2M 5-62 ATLAS