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t-UKUI -A—L Uot: ------•-------------- ------------ ---------------- - ------------------------- - ------------------- -- APPLICATION FOR SANITATION PERMIT Permit No. ----------------- -------- ------------------------------ (Complete in Duplicate) ---------- -- This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. E5 CA1_0Ad JOB ADDRESS AND LOCATION- Owner's Name-- .Lp Q ,- o - --------------- Phone---- •------------------•----------- - - -- ------------------------------- -------- Address--a /.d.----Ras-ev-e� - h ----------------------------------- Contractor's Name--- { �----------------------------------------------------------------------------------------------------- Phone----------------------------------- Installation will serve: Residence V Apartment House ❑ Commercial ❑ Trailer Court ❑q Motel F-1Other [_1--[-_ Number of living units: - .- Number of bedrooms _!.Number of baths ----1.-_ Lot size -- --0-Acie'e$--------------------------- Water Supply: Public system ❑ Community system ❑ Private X Depth to Water Table t2r4t. Character of soil to a depth of 3 feet: Sand CK Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan [❑ Previous Application Made: {If yes,date-------------- No New Construction: Yes ❑ No /VA: Yes ❑ No 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 foundation--------------------Material----.-.-----..._-_ __.----------_--__-.-----..-. ❑ No. of compartments-------------- ---- -----Size--------------------------------Liquid depth------------- ------------Capacity---------------------- Disposal Field: Distance from nearest well---- --.-.-Distance from foundation--------------------Distance to nearest lot line----------------- El Number of lines-----------------------------------Length of each line------------------------------Width of trench--------------.--------------------- Type of filter material---_-------_-_--------Depth of filter material---------------------_Total length---------------------- Seepage Pit: Distance to nearest well---.---SD--------Distance from foundation----1.A-------- Dist e to nearest lot line--.--.S --- _-- �) Number of pits- _- ---------Lining material_--JCS.C' .__--Size; Diameter__ aepth-------- ------ ------------ Cesspool: Distance from nearest well-----------------Distance from foundation-----_---------1"._.Lining"mQerial----.-____-_-_-.-.-----.___-------.-. «r ❑ Size: Diameter---------------------- --------------Depth------.. -----------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest weft-------------------------------------------------Distance from nearest building.---------._-------.-----___----..-------. ❑ Distance to nearest lot line----- - ------------------------------------ - ----- ---------------------------------- Remodeling and/or repairing (describe):-------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------- ----------------------------------------------------------•-------------- ------------------------------------------------------------------------ ---------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------ - --- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Count ordinances, State laws, and rule and regulations of the San Joaquin Local Health District. (Signed)---- , ---- ---------------------------- ---- -------(Owner and/or Contractor) By:------------------------------------------------------------------------------------------------------------------------------------(Title)----------------------- - (Plot plan, showing size of lot, location of system in relation fo wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- © ----- ----------------------------------------- DATE--.........-'f_� rG------------- REVIEWEDBY----------------------------------------------------------------------------------------- --- ----------------------------- DATE-- --------------------------------------------------------- BUILDING PERMIT ISSUED--------------------------------------------------------------------------------------------------- - DATE - Afterations and/or recommendations------------------------------- ------------------- --------------------- --------------------------------------------- FINAL WSPECTIOtd --� r �---------- - Date-------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West 0"Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California