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i vR vrri�—C uJC: /O"-Grp-----------------/1----------- ------------------------------------- ----------------- APPLICATION FOR SANITATION PERMIT Permit No. .49/41 -------------- ------------ ---- ------ --------------- (Complete in Duplicate) --------- - -- - This Permit Expires 1 Year From Date Issued Date Issued "" -_S___ � Application is hereby made to the San Joaquin Loca! Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS ALOCATI �� R&Abu")--------------- "-_. "" . -----•----------------- Owner's Name----- - - - -- - -------- --- -------- - ---- Phone Address .I .r. --1 ----- Contractor's Nam �- �- & `-- t".l..o.""--1, ------------------------------ Phone Installation will serve: Residence ( Cpartmen Ouse ❑ Commercial ❑ Trailer Court ❑ Motel Other El f r Number of living units: -1---__- Number of bedrooms _ > " Number of baths _" _"_ Lot size " __ u� _ "_ " �.,,.�1� grSupply blit s stem".❑ Community system ❑ Prat ip th to Water Table " t. - . 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 ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or ceN of permitted if public sewer is available within 200 feet.) I i Septi Tank: Distance tbm nearest well-r--�-o-".""Distan e*from d n--_ ... - �_ M eri _ No. of+ bm artments P ,"-Sized iquid depth Capacity ' Dispo al Field: Distance from nearest well. Distance from foundat'on "� "." Distance to nearest lot line----1,."f Number of lines__.--[--- ---__ __- Length of each line ;�----- Width of trench _ �� _ a Type of filter material- ; "Depth of filter mate al"""". __"" _ .. _Tota` I �""-" "_0V �- ---- Dis Seep e Pit: Number of pitfo s re t well-. Linin' mate ante from founds#ion-" stance to nearest of 1' Q 4. b ate_ Lining ial__�� ` -------Si e: Diameter - "---- !1 P x Cesspool: Distance from nearest well___--_'�".....Dis,�ance from- oundalion-.------ -------Lining mate ial_. ❑ Size: Diameter---------------- -------De th �"` # ----------Liquid Capacity-- ------------------ Privy: Distance from nearest well"""_..."-__"------------------------------- b.".._Disfance fromeEnarest building -""".__""""-_""""--"..."-._.". ❑ Distance to nearest lot line -- ----- --:-- . --- �------------- - --mow----- ------ jr Remode�t� an6/or repairing (desd*ril�):"_. � ' Remodeling !► -------------- --- ---•---------=I-.L__. �� + - --,d- - " .4k -1�- -- ,. � ----- -- -- --- --- - -_ - - -- - - --- -- i deI hereby certify that I have p pared this application and that the work will be done in accordance with San Joaquin County ordinances, Stade laws, d mules and regulations of the San Joaquin Local He Ith District. (Signed)------------ y---+ ' Clivli.G _ - �r' r'Contractor) - -- ----- -- -- --- ------ ------------------------ $ SEF nC TANK SER C1~ r y2g15 E:Nffner�va: - f�Ff�:Y 4;--------------•--- - -- - --- --------------- (Plot � - - -- - --- - - -- - ��'{Title)----- -------------- -- -- plan, showing1ize of lot, location of system in relation to I buildings, etc., ca� be placed on reverse side). FOR tin T USE ONLY APPLICATION ACCEPTED BY___.- .-_""____--_-____ ------------------------ DATE-------- -8. ---------------------- REVIEWED BY ;-------------- ---------------- DATE----- ----- ---BUILDING ------------- -. PERMIT ISSUED----------- --- -- f - t ---------- DATE Alterationsand/or recommendations:_"""-""._".._"._-".._"__""-_._------------------------------------------\------- ----------- ------------------------------------------------------- -1--------------------- ------- = -------•1'�'�T------------------------------- ----------------------------------------------- ----- ----------------------------- -------------- --- ----------------------- I - -------------------------------------------------- ,r.& ------------------------------------------------- ----------`-""-.__ - *�r� r _"""."--------------------- ".""__.." ."".""".-__ 14 ._.- ..". "-.<"--- - --------------------- ----------- 4 - '- --"-.-.-----"�------------------ ------------------ rp FINAL INSPECTION BY:- -- r ��-�� ----------------------- Date---------- �,. 1 ------------------ -------------- SAN JOAQUIN LOCAL HEALTH�DISTRICT t1101 E.Hax0l$on Ave. 300 West Oak Street l� 124 Sycamore Street 205 West 9th Street Stoektan�Colifornia ' Lodi,California Manteca,California Tracy,California F.P.CO.