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------ ---- ruKUrrt USE ic ------ �---.... ----------------------------------------- -------- APPf_ICATlON FOR SANIT TION P IT Permit No. --------- �-- ----- �--------- --------- ----- -- (Complete in Duplicate) -------- -- --------- ---- --- This Permit Ex ires I Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and 'nstall thwork rein de rib This application is madrnQcom liance it Coun Ordinance No. 49. JOB ADDRESS AND OCA N. :_ .------ �(- 1 - - ----- --••--- ----- ----- -------- BOO Owner's Na e__ _ _ - ---- - - ----------- -- -- ------ ------------------ PhonZOO Address-- al - -- ---------------------- ,�••--'�-C�-_+�-•--------------------------------------- ' Contractor's Name---------------------'---=-_---y ! - ,`, * ----------- Phone__ �'�T/ i - - - -- Installation will serve: Residence.M Apartment House ❑ Commercial ❑ Trailer Court� Iv�o,�el ] Other Number of living units: .�Number of bedrooms ______-_ Numb�tfbhs ________ Lot size __ _ ,--_____..__- Water Supply: Public system ❑ Communitysystem ❑ Private to r able .__.__-_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam Clay Adobe ❑ardi Previous Application Made: {If yes,date--------- _..._} No ❑ New Construction: Yes [] No ❑ FHA/VA: Yes ❑ No ❑ A 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 ----Distance from found t'on-_.____ r tl ��_------Mater•al___---- No, of compartments .- �� ,j `Size_ • ?liquid depth1Z Capacity' Disposal Field: Distance from nearest w`e1l_}go---Distance from foundati .l.[�_---._.Distance to nearest lot line_____-_ � i l � Number of lines___. -__-----___ Length of each lirie__ ��__- Width of trench.._ j_.___-----_ T e of filter - -- iia �m rr - q �C Yp �C�GI.�_Depth of filter material..-_- ----_-------Total len th----------- Seepage Pit: Distance to nearest well___ _ ___'__Dirstance from foundation___._.____...__ A i ____.Distance to nearest lot line__.__-- -._____❑ Dumber of pits.____:`__________-__Lining material___I_..__ __.._ _l ----._Size: Diameter- -------- --------Depth------ ------------- -------- Cesspool: Distance ,from nearest well-_._____._- Distance from foundation'.-___-----_----- Lining material. .-..______-_- ,rte --- - Y Privy: Size: Diameter Depth -- --- I - ------Liquid Capacity -- ---- ---------gals. Y= Dis#ante from nearest well_..._--y--____--_ ----_-----:.•__' Distance from nearest buildin ._ I ,. g --------------- - 7 El Distance to nearest lot line.---_________________--_, _- Remodeling and/or repairing (describe)__________________________i- � I PC Y ------------------------------------------------------------------------------•--------- = = -------- -------------------------------------- -------- -----------•-------------------------------------------------------- Y _______________________________________________________________________________________________________________________I____-_____-,__________-______k___..____-_____-_-_________._____.__-______--____-__.._.-_..__-__--- I hereby certify that I have prepared this application and that the work ill be done`in accordance with San Joaquin County ordinances, St a se1and rule rid regulations,of the SappinLocal- ealth Distric+, /- -- ------(Signed} -IA.. ------------ --$Y=---------- ---------------------=---- Con#ractor) [Title)-------------------------------- ---------- (Plot plan, showing size of lot, locationof system in relation et , can be placed on reverse side). I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_. REVIEWED BY _ ---------- ------------------------------------ --------------- DATE---/ P-�S ------------------------------------- ---- - ------------------ DATE BUILDING PERMIT ISSUED----------------------- ----------------- ------•---- -- Alterations and/or recommencla}ions:.--___.-__--__--_---- --------------------------------------------- ------ - ------------------------------------ --------------•---------------------------------------------- ----------------------------- --------------------------------_ ------------ --r -------------------------------- ------------------ FINAL INSPECTION BY:. - - - "ys's^s - -----•------ -------- Date--_f:o�Q-1101,s� --- -• ---- ----- ---- -------- �- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelion Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.p,C C.