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----'----- --- Permit No. [ ;, - c KATIONFOR 'SANITATION PL, -------------------------------- ------------ (Complete inermDuplicate) This Pit Expires I Year From Date Issued Date Issued --- r�� _-- Application is he made to the San Joaquin Local Healfh District,for a permit to construct and install the work herein described. This application is made in compliance with County O inance No 549. t '' .:y &;;� s ± JOB ADDRESS AND t AT N Owner's Name--•-----• -- --•--- ------- .:.------•-- Phone........- �_.. Address --------------- Contractor s Name Installation will serve: Residence C1}!Apartment House-'❑ Commercial ❑ Trailer Court [j /Motel ❑ = Other ❑ Number of living units: /... Number of 6edroomsl i2 Number of baths __/. Lot size ..,1e...... ,� ..............:.. Water SuPPIY� Publics stem ❑ CommunitY system io .. Private B"16e th to Water Table'r. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel 0 Sandy Loam❑ Clay Loam ❑ Clay ❑ Adobe�iardgan ❑ c Previous Application Made: (If yes,ddte--------------------) No ❑ New Construction: Yes ❑ No R?"'FHA/VA: Yes ❑ No ❑ t TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool pert ifted if public sewer is available within 200 feet.) f + e f, nk: Distance from nearest well................Distance from foundation....................Material:_r................................ _Capacity No. of compartments Size... - .. '----:"- Liquid depth P tY..... ` --il Distanc .Distance from;foundation.•.••...............Distance to nearest lot-line................. w al x Number of I nesfrom earest well.. 'L ngth of eachTine------------------------------Width of trench.............................. ..... ;5 !Depth of filter material----------------------Total length------F.--__.__...............----••�-- i Seepage Pit: Distance to nearest wel -'oe..-.__---'ID Type of filter matenal_---_------------------ _____.._--- ---------- �/ r istanc fdation.., ---------.Distance to nearest lot line-cd------ OJT ,�, 1F Number of its---- Lining material__ �°i.Size: Diameter--133_.-_------..Qepth.... _________________ [� Cesspool: Distance from nearest well........------- Distance from foundation--------------__-_-.Lining material--------------I----------------------- } ❑ Size: Diameter-------------------------------------I.lDe th------ `•-- Liquid 9Capacity Priv Distance from nearest well----------------- P i t. ______________ ___ ____Distance from nearest building ..---_•---------_______.._:-----.... ❑ ----------- Distanceto nearest lot line----•-------- ----------------- -------- ---------•----------•---_----.-.---_-.-------• ----------"-"---- -----.....-............-'-•- Istan (� Remodeling and/or repairing (describe): = --------------•---••-----"-""-•------------------- ..............................•............. g . ------""•---"-------------------•-----_------------•----"-"-"•"----------------.--:-------•-----------------•-•-" -----=--------•-•----------•---•- 1 __.__t___-_...._..______------------------------- ........---------------------.................. ---------------- --------------------••-_-__.....----_-.-•__--.-_----__-_-__-_-_._-____-______..--._._.-_--__-•-___ .. -- ._ Y I hereby certify that I have prepared this application and'that the work will be done in accordance with San Joaquin County ordinances, St laws, and r es and regula 'ons of the!San Joaquiti�'Local Health District. (Signed) = -----------------•-----•------ ner and/or Contractor( ----------------- Plat Ian, showing size of .,. ~' BY:--------------- ---- .......................... --- --- --- --- ----.----•------(Title)--------- ' ( p g lot, location of system in relation to well ildings, etc., can be placed on reverse side). I FOR gEPARTM T USE:;ONLY ; ;l ;l APPLICATION ACCEPTER BY ._.r.. -- -•---........-••----•------- DATE ,� '' .3....`...�t?. ....... REVIEWEDBY ---------------------------------- DATE. --------- . BUILDINGPERMIT ISSUED---......••--•----- ---------•---- i :' F ------------ DATE......... ....................................... Alterations and/or recommen ations' ............................. -- --.. f3!• ----------------- �f ISS• _._�.- ._A..................................... .! ' j ..._._ .. ...._.- .-_.. ` .4 i :• x `1.......................................................... FINALINSPECTION BY--------------------------------•------ :: ;! Date = ----------------------------------••-• , SAN JOAQUINLOCAL HEALTH DISTRICT ' 130 South American Street 300 west Oak Street: 124 Sycomorie Street 205 West 91h Street Stockton,California Lodi,California+ 4 I' Manteca,California Tracy,California q rx Eb 9-99 2M 661_ 7LA9