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NJK Ul rH(_L USE: <br /> - - <br /> ---------------------------- L .- .._ APPLICATION FOR SANITATION PERMIT Permit No. <br /> -------------------------- --------------- ----- --- (Comple+e•in Duplicate) <br /> ....... --------- _ Date Issued <br /> This Permit Expires, 1 Year From Date Issued <br /> w aApplicafion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> i <br /> JOB ADDRESS AND LOCATION-_' : lam---. ----/ _.._._ � <br /> ---------------------------------------- -- <br /> -------------- <br /> Owner's Name---------- -•-- �� �.1.�.�.T.l� '. . <br /> s� -. Phone---- ------------------------------ <br /> Address--------••---------•-•----`�'-1Q-�--------• -•- -- --r-• --- - r <br /> ------•------ - -•- <br />` Contractor's`Name..--.. ;--le .� <br /> .. Phone. O5 <br /> Installation will serve: Residence Apartment House E] Commercial ❑ Trailer Court ❑ Motel D Other <br /> El <br /> Number of living units: -.(.-__ Number of bedrooms .3_. Number of baths`Z-_ Lot size .._-- //00_ <br /> 6 -------- <br /> Water Supply: Public system ❑ Community system ❑ Privat11 1e ❑/f/epth to Water Table N . ft <br /> Character of soil to a depth of!,feet- Sand ❑ Gravel ❑ Sand Loam Clay Loam Clay Y ❑ Y ❑ y ❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date---------- ---- - ) No ❑ New Construction: Yes ❑ No ❑ -FH' A/VA: Yes ❑ No ❑ <br /> `TYPE"OF`INSTALI:ATIONRAND•SPECIFICATIONS; � - - _ <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet) <br /> Ta Distance from nearest well.-��.0_�__._._Distance from foundation._/O�__--.__-_Material <br /> .4-� ��%� , <br /> No. of compartments-_.__-- _ - <br /> Septic { Size ...-Y �r Liquid depth.._.C !r <br /> e is -- -- --- CapacifiY--sl - <br /> Disposal Field; Distance from nearest well Distance from foundation-.-J ---------Distance to nearest lot line_.... �____ <br /> Number of iines__W- ---------------------Length of each line.._915. .- Width oftrench_-..-I7�..4r!____..----______ <br /> Type of filter material k.. <br /> -- Q <br /> -----------_Depth of filter material_-.-.��____ __-Total length--.-_-�_ <br /> Seepage Pit: Distance to neare"st well._--------------------Distance from foundation------------- ---- <br /> Distance to nearest lot line.... <br /> ❑ Number of pits._.F------------------Lining material-------------- ------- Size: Diameter---------------- ----- Depth-,.... ..........................- <br /> esspool: Distance from nearest well ................Distance from foundation------------------.Lining material------------------------------------- <br /> D ' <br /> Size: Diameter. .. Depth------------- -----------------------------------.-Liquid Capacity------------------- <br /> gals. <br /> Privy: Distance from nearest well_----_-------------_ <br /> .......................Distance from nearest buiidin • h <br /> ❑ Distance to nearest lot line g_...-_--..._ <br /> ---------- <br /> Remodeling and/or repairing (describe): <br /> ------------------------------ <br /> ........ ----------- <br /> ---------------.--------------.------------------------.--------------------------.---------------------------------------------------------------------------------------------------------------------------------- <br /> ---------- <br /> l <br /> .............................................................. ......_._--.-...._._.-..._.____-......._.....__...--__._-.-__....-._...-_..-....__...-_..-._..-.._..._..--._-.-•---_--.-..._--------.._.---------- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and remqulations of the San Joaquin Local Health District. <br />,-(Signed)__. _ T <br /> - — - -.--- .___----- ------------- _..(Ow <br /> By:---- = (Owner-and/or-Contractor} <br /> -------------- -(Title)----- ----- ----- ----- -- -- <br /> (Plot plan, show i sl a of lot, location of system in relation t ells, buildings, etc., can be placed on reverse side. <br /> E <br /> FOR PARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY.-- E_R_.O! ------ ------------- -- DATE '�.�- ��.-G_ <br /> REVIEWED BY_ ----------- <br /> ----------------------- ------ <br /> ---------- DATE------- <br /> --------------- ------------- <br /> BUILDING PERMIT ISSUED `----- -------------- -------- <br /> ------------ -------- �--------- --- ----- -------- . DATE-- --------- --------- ---- ' <br /> Alterations and/or recommendations:--- <br /> " --------------------------------------- •--------- ------ <br /> -•-------------------------j <br /> ---------------------- <br /> -- ----------- <br /> --- ------------------------ --f-------------- -- --------- ---•-- <br /> P <br /> .................... ............."------- -"---......_---.-._....-------------- --_....-.----------------.-------...._--.-_..----._...._-----------.-..-._.--------------------- <br /> --------- --------- <br /> .. .................. <br /> ----------- <br /> FINAL INSPECT <br /> Date ...... S._.. ."_ !J..._. ... --- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> ` 1601 E.Hazelton Ave. 300 West Oak Street <br /> 124 Sycamore Street 20.5 West 9th Street I <br /> Slockfon,California Lodi, California ` Manteca,California <br /> E.H.9 2M 1-67 Vanguard Press ` 3j Trocy,California 1 <br /> yy 7K <br />