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APPLICATION FOR CITATION PERMIT Permit No. (Complete 9' 'plefe in Duplicate) This Permit E Date Issued --- Expires 1 Year From Date Issued AppliA ,"p- Sa'njoaqu.in cation is hereby made t.'th' Local Health District for a permit to construct and i stall the work herein described, This application is made in compliance with e County Ordinance. No. 549- JOB ADDRESS AND LOCATION--------- AV.-_, - - - - ---------- Owner's Name---------------- e Add ---------------------------- -----------------------------------------------11 --------- ---------------------------hl�h ress ---- AV- ---------------------i------------------------------------------...... Contractor's Name-_-- ---pp:LtA...4eptic Tank Servi e, Inc '- , - --------------------------M_------9------------------ ---------------------------------- -------t. Phone-49-1....�—i269 ---------------- Installation will serve: Residence Apartment House F .1 . Commercia C']`.Trailer Coui�.t,, 0 Motel El Other Ej Number of living units: Number of bedrooms ....2 _ --------------_----- ---- Number of baths._.,___ Lot 150ix 108 "11r .. 11 i. ;. ---------I-----------;---------- Water Supply: Pub -system El Community system E) Private E] Depth to' Water Table ff. Character of soil to a system of 3 feet: Sand E] Gravel E] Sandy Loam E] Clay Loam E] Clay E] Adobe [2[ Hardpan C] I j - ❑ I ❑ I ., 4 Previous Application Made: Yes 0 No D'L New Construction,: Yes N No [:] FHA/VA: Yes: No RI 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------114�-----Distan`c& from orn foundation---2=_Q...........Ma.iX, �9_* nt No. of compartments--------- __;W_&41 X4 liquid depth---3b_1 IJ------ 50--- --------- ----Size---6-1 -- ------- E -----------Capacity-, f %) � I y-----------Q--------- Disposal Field:, Distance from nearest well------49-----Distance from foundaticn--.19...........Distan(ce to nearest lot lin,_5' -------------- Number of lines------------1- - -----------Length of, each line__-_-90----8-ii----- of trench------2_1� Tye of filter material___________r6-Ck-----Depth of filfe� maferia_11------------ ---Total length----------901 7---- Seepage Pit: Disstance to nearest"well--------;IQ-____-__Distance from foundation____._1T Distaniceto nearest lot line------51 Pq Number of pits----------1---------Lining material_--rg.Pk --------Size: Diameter-------- H I I....... --)3____,_A___.,Depfk------- ---------max.---------- 41 -- Cesspool Distance from nearest well_________________Distance from foundation------------------- Lining material----- ------------------------------- El "Diameter------------ -------- ---------------- q Lu;d1 C a pacify ------------------------- ---------------------- I ---------- -----------------gals. Privy, D;s'tance from nearest well______ —------- ----------- -------_Distance from nearest building------------- ---------------------------- ❑ Distance to nearest ]of line._- ------------------------------------- ------------------ ------- Remodeling and/or trepairing (describe):---------------I --------------------------------------------- ---------- -1--- - -------------------------------------- -------- ----------- __------------- �_.r----------- _4--- ----------------- ----------i4 7 ---/ --- -------��-;/, ----------- --- ------------- ----- ------- ---------------- --------- ----- --- - ---------- Z Z_ -V------------------------- --------------- ----------------- ------------------------------------------------------------------------------------------------------------------------------------------------------ -------_. I he 6y---certify f -at.1 h.ave.prepared this application and that the work will be done in accordance with San Joaquin County 6rdina es. SWe",law's, ana(rules "and regulations of the San Joaquin.Local Health District. (Signed).-------------D-elt dry 0. _ 1C,.Tank---Se i q e-, - - - ---------.. .... ------------ -----------------------------------------(a�wner`and/or Contractor) By:---------- 1, ----------------------------------------------------------------------------------------(Tif Iej' Gen. IM - Gen. I_T� :-------- --- ---- ---- --------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can ObI pliaced,on reverse side). 7kA_t FOR DEPARTMENT USE ONLY 110 ----------- - - ---- -------------------------------------------- DA APPLICATION ACCEPTED BY---- -- E_ REVIEWED BY 11�_4_ -------------------------------------------------------------*------------- DATE- ---------- ;�v-------i�------------------------------ BUILDING' PERMIT ISSUED-------------I -------------------------------------—-------------------------------------- DATE A#raf -s ind or,- ---70 a lf ion reco o' --------- ---------------- --------------------------------------------------------- ---- ------I_--------------------------- --- .--- ---- T, - - - ------ � __ 711- - ----- --- -------------—------------------------------- ---- ----------------- - -- - - -------- - ------- ---- ----------- ----------- - ------------------- --------- ----------------------------------------------------------I ------41;2111��er Ilk ----- --------- --- -- -------------- -------------------------------------------------- -------- �d FINAL I SPECTIO Dae...... Y�_ -------------------------- A • SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American S+ reel J300 W.,t dail:-nSfreet 132 Sycamore Street 814 North "C" Street SfoI — :*X , c 'rkton, California k Lodi,"C.iionia A.. Manteca, California Tracy, Californiaff ES-9-2M Revised 8-'59 F.P.Cu,