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Permit No /S -. � ArrLICATION FOR SANITATION PER'Wft F -..--- ------ --- Date Issued �� Q - -- (Complete in Duplicate) (, - ------------------------------------------------_- This Permit Expires 7 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descrbed. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AN LOCATION.. ©t7...wC1 AGN J ----------------------r------------------------•-•--- ------....----------•------...._--•---..... Owner's Name- ------------ Phone.----------------------•---- Address----------- '3' r Contractor's Name_- ----------.. -7= ---------------------------------------------------------------- ................... Phone.................................. Installation will serve: Residence, Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ r. Number of living units: ..._*Number of bedrooms A--- Number of baths A_ Lot size ................................... Water Supply: Public system [6]-11fommunity, system ❑ Private ❑ Depth To Wafer Table .`p ft. Character of soil to a depth of 3 feet: Send ❑ Gravel ❑ Sa dy Loam❑ Clay Loam ❑ Clay C] Adobe[�ardpan ❑ Previous Application Made: (if yes,date-__-__._.-----_-I No [87New Construction: Yes �No ❑ FHA/VA: Yes U!r No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic Tank or cesspool permitted if public sewer is available within 200 feet.) i Septic Tank: Distance from nearest well..(YA.A/._,$Distance from foundation---&------------Materiel_../..... r�..-_.__...--.. [ No. of compartments_.___ ---------------Size....4 5-1!_C7....,.-Liquid depth._.Q._..............._Capacity...l.br.p.... Disposal field: Distance from nearest Distance from foundation..i?_'........Distance to nearest lot line_ /....... Number of lines.........2 ___________________Length of each line...Ajm!f__.�`----- ..Width of _.............._...... Type of filter material._._ tr_G.�(.....Depth of filter material::./5`.____.._.._-Total length.../.Ao....._------_............. Seepage Pit: Distance to nearest well _--..........Distan rom foundation_.16..........Pistance to nearest lo} line.../....... 0 r,✓ Number of rts._ Linin materia l.. Size• Diameter.._ i L� P -- 9 �k - - - Dep+h_�_``r.. - Cesspool: Distance from nearest well_......----_Distance from foundatiorr.-----------------Lining material...................-................ ❑ Size: Diameter-------------...................._Depth----------------------------------------------------Liquid Capacity.....................-...gals. Privy: Distance from nearest well-_......._____-___-___-----_---.__._- -----Distance from nearest building----.---_--------------___-_-------- ❑ Distance to nearest lot line---------------------------- Remodeling and/or repairing (descri e):-Z& 1_ __- - - ---- --- ------ ----------- - - - I hereby certify that 1 have pre ar d # IF Ica+i and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules egu tions of f San Joaquin Local Health District. (Signed)------------------- ------ - ------- - ------ --------- -------(Owner and/or Contractor) By:........---•------------- - -- --- ----,.---- ----_------------------------------------------------------(riifla)--- ---------------------.... (Plot plan, showing sae of lot, to tion of system1n relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY..... -`---------111f - - -..............._--.................. DATE-- =moi - REVIEWEDBY------------------------------------ --------------------------------•--........................ DATE......................... ----- ---- BUILDINGPERMIT ISSUED---------------------------------------- ----------------------..................................... DATE.....................................-.......-...... Alterations and/or recommendations:.-------` --------- `, _..-----------------------------------------------------------. - ty-il........----- -----------r------------------------------------•------------ - ------------------------._.. -- ,a-- 4 r ---------i°�tl< J am. .. _.. _a, , _..�.P�_. ---- --------- -- ------------------------------- --------- ------------------------------------------ -- - ---------- - ----------- ----- --------------------------- FINAL INSPECTION BY:-----------------I..�L.- rte`-------------------- Date.------..C'-..a+> --_6=�................................... SAN JOAQUIN LOCAL HEALTH DISTRICT 130 Soath Arn*rlcan Stmt 300 Woo Oak su..t 124 Syc9mon Sfr..t 205 W.,1 91h St rwl Stackton, California Ledl,California Manteca,California Tracy,California ES 9 REVISED 9.59 2M 5-62 ATLAS