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FOR OFFICE USE: - ------- ------ 4----- APPLICATION 1=0R SANITATION PERMIT Permit No. C. ....--- ----- . ...-- - (Complete-in Duplicate) 3 This Permit Expires 1 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. c JOB ADDRESS A OCATIO U11, II , 1 --------------------------------------- Owner's Name. � ... J -- -------------- --- -- ------ Address -------------- Contractor's Nam G�C.��. ✓ - � PhonA.,67G.X-CrC ------ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Mote4 ❑ Other ❑ Number of livin units: g 0)____ Number of bedrooms _2__ Number of baths-_I---- Lot size --- ___________________ Water Supply: Public system ❑ Community system ❑ Private K Depth to Water Table 7A'. 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-__--- ._._. _ J No`54,- New Construction: Yes ❑ No ❑ FHA/VA: 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 weal...... Distance from foundation...................Material ____..._......_-- - _-.... r No. of compartments-- - ---- - - - f -.-Size-- --- -- .. ----------- Liquid cljpth---- - -- - --- -- Capacity------ r Disposa} Field: Distance from nearest well_.7_&..---. .Distance from foundation../C__------ _.Distance to nearest lot line--.S........... Number of lines __- .. .. ' Length of each line.. _. __._......._Width of trench.... rrr ^ Type of filter material__ '....c._ ___ _Depth of filter material___-1... y`___.___Total length-----..----------- - ___r_......--..__ V� G' t F r / V Seepage Pit: Distance to nearest well. . �(G_.._..._,.Distance from f "undafion__.Z .___ Distance to nearest lot line..-57_-_____ Number of pits._GT(. -. � Lining material. Size: Diameter_- 7�t l-t- Depth_. C'.-'______________..- Cesspool: Distance fjom nearest well ................Distance from foundation________________ Lining material_____---..__.-____.____._------..._ 171 Size: Diameter- - _ --- - - - ..... -------.Depth- - - ---- -- ----------- -- -- - -------Liquid Capacity. - - -- -------------gals. Privy: Distance from nearest well........... .._._______-_ -------Distance from nearest building-_. -- ------.____________ ❑ Distance to nearest lot line .- - - ---- ---- ------------------ --------------------------------- ---------- - Remodeling and/or repairing (describe):..._ - -I -- .-.. --�- �.--:' ie - -- -------�-�- ' - -�- � , ------ ---- c--------------- slit I hereby certify that I have prepared 1s application and at the work will e d e in accordance with San Joaquin County ordinances, Stws, and rules a regu ations of the S Joaquin Local Hea h Di rict. ! 4 J Si ned 9 ------ {Owner and/or Contractor ( By:------- ------- AGI L L'C (Title)-- --- ---------- (Plot plan, showing-size of lot, location of system in re.1.4n to wells, buildings, etc., can be plat on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY 1( -- --- --- ---- DATE f '� --------------------- REVIEWED BY----- - -- ------ - ------------- ------------------------------- - - -- -- - -- --- ---------------..-........... DATE- ... ----------------------- BUILDING PERMIT ISSUED------------------ -------- ------------------- - ----------- --- -- . DATE--- Alterations and/or recommendations:. .. XC _.� L: ,C. .'=. ._ Qh: C ---5 �11--�_ - --- ----- - V-1 L ,� � -r��l -_11 •- -- rc-- - - �l- cf, - . .....- z?` �1..0_r a��f<, --- - ------------- ---- ... ----------------- - ------------ - - ---------- . .. . ..... ....... Ff �. ' .ti NAL INSPECTION BY;. � ____. ,, (/- � ;`y_ ---.._- Date--- ---�� _- �� S UIN LOCAL HEALTH DISTRICT 1601 E.Maselton 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