Laserfiche WebLink
3 APPLICATION FOR :SANITATION PERMIT Permit No. - -.- -- <br /> d�--.,1-�'.y t-- f <br /> t (Complete in Duplicate) �o <br /> Date Issued -- Y--------3 <br /> Application is hereby made to the Sen Joaquin Local Health District for a permit to construct and install the work herein described. <br /> E This application is made in compliance with County Or 'finance No, 549. <br /> JOB ADDRESS A LOCATION. _ _ _ <br /> --- <br /> Owner's Name-. -. Phone <br /> ------- <br /> Address----- -- :.._.- <br /> A1 ••-.- - -------------••-------•----... <br /> Contractor's Name - -------------------------------------------------•- --- ---------------------•----------------------- Phone-----------------------_----------- <br /> Installation will serve: ResidenceApartment House E] Commercial E] Trailer Court ❑/ M tel E] Other ❑ <br /> Number of living units: _Z_ Number of bedrooms _-?- Number $ baths X_. Lot size __1------ -- ------------__-_---_-_--------__-_-------- <br /> Water Supply! Publics stem Community stem ; <br /> PPYi Y ❑ y y ❑ Private Depth to Water Table ----__- ft. <br /> Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loa Clay Loam 0 Clay ❑ Adobe /Hardpan ❑ <br /> t [ � • <br /> Previous Application Made Yes ❑ Nod.� New Construction: Yes [VNo ❑ �,,� ,, .t ,, <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if ublig sewer i available within 200 feet] ' <br /> r <br /> Septic ank: Distance from nearest well_ _ .�ista ce fro ounda ion - ------------ at, i <br /> +� ---------- <br /> 1 No. of compartments:_-------- 'J-t------'Si e ._Liquidndpp 4 Capacity------ i <br /> 4 1 � --- l_ ` , <br /> Dispa I Field: Distance from nearest weft -------_- +stance from foundation- --_ istance to nearest lot line. <br /> Number of lines---------- -`-;� { -------- ,Length of each ine---------�--k_oil-----Width of trench----------.r -- <br /> T ear filter mates t <br /> Yp r €: epth of filter i aterial----__�--- __- ---Total length-------------- ,I- I <br /> Seepage Pit: "D-fsfance;to nearesfwell-"-- ----------------Distance from foundation------------ -------Distance to nearest loft line <br /> ElNumber of�pits---------------------Lining-material-----------------------Size: Diameter------------- - -------Depth------ -------•--------------- <br /> Cesspool: Distance from nearest well-___---1-t__-,�D,istarace from foundation----- -----------Lining material--.__,-.---_---_--_- <br /> t " <br /> ❑ Sixe: Diameter ----- Dph�-- :..-e....- <br /> Liquid Capacity-. ----gals. <br /> Privy: Distance from neap st well---------------_----------;I�_-------------____Disfan�Yfrom nearest buildin <br /> ❑ Distance to nearest Dtfline #------------------ F- - <br /> ---------------- ---- <br /> Remodelin and/or repairing describe 6 <br /> g p g ( ] - ------------ -------------- <br /> *c ---•---------=------------------------------------------------------••------------------------------------- -- <br /> •---- '•---•-------------- <br /> ---•----- <br /> ; -------- r! <br /> -- --------------------------------------------------------------------------------------------------- <br /> I hereby certify that l have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the+,San Joequinkocal Health District. <br /> (Signed)---- A4 A <br /> --1---------------------; --- -�: ------------ -----------------------------------------(Owner and/or Contractor) <br /> By: -------------------------------------- ------------- =�; � ----------------------------------------Title <br /> (Plot plan, showing size of lot, location of system in i•elation:to wehs, buildings, etc., can be placed on reverse side). <br /> FOR DEPARtMtNT USE ONLY <br /> APPLICATION ACCEPTED BY-5- ----- ----------------- --------------- ----A---------------------------------------- DATE <br /> ----------------------------------------------------- <br /> REVIEWED BY <br /> --- ---- ------------------------------------------I----------------------------------------- DATE <br /> t----------------------------------------------- <br /> BUILDING PERMIT ISSUED------------------------------------------- --------------------------------------------------------•-- DATE------ ----------------------------------------------- <br /> Alterations and/or recommendations:-_------ ----- <br /> ----------•-----------•------------••---------•-•----•---•---••-•-----••- --•-•-------•-------------- ------ <br /> --•-------•-• •----- ---•-•--•---------- ---------------•----------- ----------------------•--------•-•-----•----------------- <br /> ----------••--•---------- ­-------------------------- --------------------------------------------- <br /> ------------------I----------------------- <br /> ------- <br /> ------------ <br /> --•-------- --- - --------------------- <br /> FINAL INSPECTION BY:.. -------'----------------- ----------- Date 1 <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 Wes+ Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> 1=S-9-214 10-52 Revised W-2100 <br />