Laserfiche WebLink
FOROFFI E U E: <br /> a ------- <br /> ---------------- ------------ ------------------------- APPLICATION F8R SANITATION PERMIT Permit No. 4f.IF:• ' <br /> ---------------------------------------------•----------- (Complete in Duplicate) DateIssued - <br /> 6 <br /> --------- This Permit Expires 1 Year From Date Issued '------- <br /> Application 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. 9. <br /> JOB ADDRESS AND-LOCATION.._._ <br /> _ ��-••---•-••------------------------------------•---------------------••------•................----•---- <br /> Owner's Name----------- <br /> Address..................... <br /> 5 <br /> Contractor's Name = - ---------- � ••---------------------- ---- = . Phonl B <br /> Installation will serve: Residence Er'-Aparfinent House ❑ Commercial ❑ Trailer Court ❑ Motel b- Other p t <br /> Number of living units: .__ Number of bedrooms __Pz. Number of baths ./. Lot size ........ ..........:....................:------- <br /> Water <br /> ....Water Supply: Public system ❑ Community system ❑ Private 93 '`6epth to Water Table... ft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam ❑ Clay Loam ElClay❑ Adobe ardpan❑ <br /> Previous Application Made: I I f yes,date____..___._ `.-----) No ❑ New Construction: Yes ❑ No [9- ii/VA: Yes ❑ No ❑ i <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> ( o septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Distance from nearest well_________________Distance from foundation--------------------Material.......... <br /> .___________-.............. <br /> No. of compartments--------------------------Size--------------------------------Liquid depth------------- --------•-•-Capacity....................... <br /> os Fi • : Distance from nearest well_________________Distance from foundation....................Distance to nearest lot line................. <br /> Number of lines-----------------------------------Length of each line---•--------------------------Width of trench----------------------------------- <br /> Type <br /> ---------••----.----• _ -Type of filter material-------------------------Depth of filter material-----------------------Total-length_--'-_--____._.........__.__. <br /> i �- f , <br /> Seepage Distance to nearest//well ---_.._.Distance foundation---J`�__s�......Distance to nearest lot line Q_..._.. <br /> 93-11 Number of pits------,C_____._ '�---Size: Diameter____ .3 � G. <br /> Lining material Q Depth-__6Z, <br /> Cesspool: Distance from nearest well_________________Distance from foundation------------..------Lining material-------.............................. <br /> v <br /> El <br /> Size: Diameter--------------------------------------Depth..----------------------------------------•-------Liquid Capacity------------------_----...gals. <br /> Privy: Distance from nearest well--------------------------------------------_----Distance from nearest building-------.------------------ <br /> ❑ Distance to nearest lot line-------------------•----------- <br /> Remodeling and/or repairing (describe)_-------------------------------------------------- <br /> .. `� <br /> --•-------------- --------•------••--•-•---•-•--• ----•------_---------------------------------------------------...-----------------------------------------------...-----------------------------••-----------.---- <br /> 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances. St aws,2andules and regulations o the San Joaquin Local Health District: <br /> (Signed) ``---`' ---- --------- ---------------------------------------------------­ •- -.(Owner and/or Contractor) <br /> By � t <br /> ' - ..(Title). ---------- <br /> (Plot plan, showing size of lot, location of s em in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY { <br /> APPLICATION ACCEPTED BY---- <br /> -----------------------••--------------- DATE_'__:`"_. .:.:. # <br /> REVIEWEDBY }------------------------•• -------------------------- ------------------------•-------------------- DATE--------- <br /> BUILDING PERMIT ISSUED...................------------------------------------------------------_----------------------- DATE--------------...._. <br /> Alterations and/or recommendations:------------------------------_-------------------- f <br /> ..............•------------------•--------------------------------------------I------•--------------------------••-------- i i <br /> -----•--•---------- <br /> ------ <br /> -.. -------------•------------- - ----•-•-----: .,e,. <br /> -••............ .... ............. ..................... ------------- ---- <br /> FINAL INSPECTION BY--- -- ---- --- ------------- <br /> ----- -------------- ------------ - Date-- > <br /> a• <br /> AN JOAQUIN LOCAL HEALTH DISTRICT I <br /> 130 South American Street 300 Well oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> r6 4 REVISED 8.99 @I+1 5-61 ATLAS <br /> h <br />