Laserfiche WebLink
- APPLICATION FOR SANITATION PERMIT <br /> Permit No. __��!•--f--_._ <br /> (Complete in Duplicate) <br /> f P Date <br /> tJ't lt.Plissued ---------- -=------- <br /> So• I�Iq.� <br /> CtZL 10 L`t t- t ' lr�� Gtr �.'� . <br /> Applica4ion 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 /> L arc► 2 e o- ' ----------- <br /> I - -------------------------------------- <br /> JOB 4ADDRESS AND LOCATION - - .- - -- <br /> V »_ �k`� t ........ Phone-----)A.0_---------- <br /> Owner s Name____ ________D__-__--!""^ - -- - <br /> Address...._i__s --...-6 O�L d---------- - 1�!1--�_G�..... ... .. ..'---------------------------------•------------- ------_------�-�---"------- <br /> } ------------- ------ Phone.`l ..... _' ------------- <br /> Installation <br /> J��- <br /> Contractors Name._�.C'a4�4�_.__..-,-•--••----------------------------------------- --------------- ----------- <br /> Installation will serve: Residence E( Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑' Other ❑ <br /> Number of living units: _.�___ Number of bedrooms _!+. Number f baths ._I---- Lot size -------- '-_k;Ak -------------__----------- <br /> h <br /> Water Supply: Public system El Community system El _Private Depth to'Water Table _ 4- ft. <br /> Character of soil to a depth of 3 feet: Sand Gravel El Sandy Loam . Clay Loam El Clay ❑ Adobe❑ Hardpan Ll <br /> Previous Application Made: Yes ❑ No New Construc+ion: Yes &T No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: ` <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well--,---------------Distance from foundation--------------------Material------____--.--.-----__._-__--____--.._--.---_.-. <br /> No. of compartments-- ---------- ----------Size-------------------- •---- Liquid depth--------- --- ------------Capacity----------- <br /> ; <br /> 04 <br /> Disposal F'e d: Distance from nearest well_ 0---.----Distance from foundation..___,�0_---_--__.Distance to nearest lot line-__�__--_--.-- <br /> � Number of lines-----------I---- ------------ Length of each line-------�-�-�;----------Width of french------�`-'--T---- --------------- <br /> �� t1 ►> a � l Type of fi{ter material--t -------- of filter material____..'°__...__..__.Total length---------6-a------------------••------ <br /> - Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line_-_---___------- <br /> ! ❑ Number of pits------ --------------Lining material---------- ------------Size: Diameter-------------- --------Depth.-------------------------------- <br /> Cesspool: Distance from nearest well______________ Distance from foundation---:--------------Lining material____-.-----.---_-.-_-_____--_-_---._-. <br /> ❑ �. 1 <br /> Size: Diameter--- ----------------- --------------= Depth-------------- --------------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well........................................ ......"Dis+ante from nearest building------------------------------------------ <br /> ❑ F Distance to nearest lot line-------------- -------- -------------.-...--------•---------------------------•-------------•--------------------•------------------- <br /> 1 [ <br /> �L 1 <br /> Remodeli and/or repairing {describe):------ '"�'- ----- 4 ---!-='-----• "----•- ---- -- ...----------•-------. <br /> ---- ------------------- - <br /> ---------------------- ---------•---------------•------------------------- ----------------- <br /> -----------------------•------------------------------------ <br /> - ---- -------- -- ----- - -----------------------------•----------- --•---•--••--------------------------------------- <br /> ---------------------------•---------------- --------------------- <br /> hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> i ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> ! ----------- --------------------•-------------{Owner and/or Contractor) <br /> (Signed)----- ��--------- --------- <br /> ( r� <br /> ----------------------------------------------- {Title)--� <br /> (Plot plan, showingg sizf lot, loceti of system in relation to wells, buildings, etc., can be placed on verse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY -------------------------------------- DATE = r ---------------- <br /> -- ------ -- <br /> BY------------------------------------ --- --- --------- - - ----- <br /> -- .-- . -- � _ f DATE -------------------------------- <br /> REVIEWEDBUILDING PERMIT ISSUED----------------- ------- ------- ----------- DATE... <br /> Alterations and/or recommendations: ----------------------------------------------.--------------------------- <br /> t -----------------------------------­------------------------------------------------ <br /> ---------- ---------------•-------------•--- <br /> ----------------------------------- <br /> -------------------------- - <br /> t <br /> f�i • -ate �II���/// <br /> FINAL INSPECTION BY------- �� Date---------- --------- <br /> f <br /> ,. <br /> t � <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 132 Sycamore Street 814 North "C" Street <br /> 130 South American Street 300 West Oak Street <br /> Stockton, California Lodi, California Manteca, California i Tracy, California <br /> ES-9-21A 145446 ATWOOO 12 5a - <br />