Laserfiche WebLink
APPLICATION FOR SANITATION. PERMIT P" rr{ft No. ..°- <br /> S II <br /> VI �' (Complete in Duplicate) Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to y <br /> d install the work herein described. <br /> This application is made in compliance with County Ordinance 549. <br /> JOB ADDRESS AND LO TIO. ---------> , '� ---------------------------------------=---------------- <br /> Owner's NameI--�-- - ------------------------------'------------------------------ <br /> Phone <br /> ------------ <br /> Address <br /> - ` <br /> , . <br /> Address------------- r? ;+ ---------•---------------------- <br /> � � �� -------- <br /> ----•------ <br /> Contractor's Name---- _. -,_ I Phone <br /> Installation will serve: Residences Apa ,1.rtment House . Commercial ❑r"Trailer Court El Motel F-1 Other El <br /> Number of living units: f i"": mber of bedrooms �1- Number afhs __/__ Lot size ____ _ -X -a- ----------------------- <br /> . x <br /> Water Supply: Public system Community <br /> �Zw. <br /> ity system ❑I Privalte Depth to Water Table _______ ft. <br /> Character of soil to a depth of 3 feet: SGravel�❑ Sandy Loam' ay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> Previous Application Made: Yes ❑ No Constlruction: Yes No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: 1 <br /> o septic tank or cesspool§permitted if public se I r is available within 200 feet.} <br /> � (Np fl� <br /> Septic Tank: Distance from,nearest weIJistance frQM foundation---f k______.Ma IQ <br /> No. of compartments- -- -- --------- - i e--r 11-- /1- � Liquid depth------=--;>Capacity-•- ----------.._ <br /> .. ... �.f <br /> Disposal d: Distance from nearest well______-Distance from foundation_ VY__ Distance to nearest-l7a�tyne__ ______________ <br /> Number of lines_________ __ dength of each line_ L.Width of trench_---s�__________________________ <br /> Type of filter materiaLjj: Depth of filter material - Total length <br /> A Seepage P' . Distance to-nearest well__1f1`_ ---------Distance f m fo dation__ __----Distance to nearest lot line______- <br /> Number of pits____�---------------Lining m dterial__Art�s.G�i C_"Size: Diameter__--- �_-________.Depth____��____ <br /> Cesspool: Distance from nearest well-----------------Distance from foundation------------}-------Lining material_______________________________-__--- <br /> ❑ Siize: Diameter----------- --------------------------Depth-----------------------------------------------------Liquid Capacity: . -----gals.: <br /> Privy: Distance from nearest well------------------- _-----------------------------Distance from nearest building__________________________________________ <br /> [] Distance to nearest lot line___-:-.----------1.N----------------------------- <br /> Remodeling and/or repairing (describe)---------------- -------------- ---------------­---- <br /> I <br /> -------•--•--•-•--•--••--------------------------------------------------------- � ----------------------------------•----------------------------------------------------•--•----------.------------- <br /> ----------------------•----------------------• .............................-- =M----------------------------------•---•-------------:----------------------------------------------------- -------•------•- <br /> . ------ ------ -------- <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 la s, and rules an4 regulations of the San Joaquin Loco Health' Di-strrict. <br /> r-eI '��1. - -- `--------- -.{Own and/o ontractor) <br /> (Signed)------------ <br /> /� f <br /> gy--------------- L - - 'I {Title} ----------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> 11; <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-- ------ <br /> ---------------------------------------------------- <br /> � ------------------------- DATE------------- " ------------- <br /> REVIEWED BY li!s ,..�. DATE ------------------ <br /> BUILDING PERMIT ISSUED__. = --�----------------------------------------- DATE------------------------------------------------------------- <br /> BUILDING <br /> and/or recommendations----------------------------------- ---------------------------------------------------------- ------•---------------•-----•--..._------------------------- <br /> --- <br /> ------•------------------------------------------------------------------------------------------- <br /> ----------------- ------------------------- -------------------------------------------------------------------------- <br /> ----------------------------------------------------=--------------------- -------------------=ll------------- ---------- ------------------------------------ - ---------- ---------------------------------------- <br /> l. /'� <br /> FINAL INSPECTION BY:------if _-- - -------------------- ----------- Date LJ �f` � <br /> kSAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Streef s 300-Wesf Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M 8-51 Revised W-2100 <br />