Laserfiche WebLink
APPLICATION FOR SANITATION PERMIT Permit No. �71---7 <br /> (Complete in Duplicate) / <br /> Date Issued A/ <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 No. 549. <br /> JOB ADDRESS AND 10CATION <br /> Z/----------el.. .... <br /> Owner's Name-------- -------- <br /> Address-------•-- <br /> Contractor's <br /> ddress.......... --------------- <br /> Contractor's Name------____--_--_- — - -- - ---------------------------------------- <br /> 1 7__-•--------- -- -----------------------.__ Phone.----•----------------------------- <br /> Installation will serve: Residence 16- A arfmenf House E] Commercial El Trailer Court F] Motel 0 Ofhe 0 <br /> n U <br /> Number of living units. --I--..:Number of-bedrooms -1/Number of-baths -1---- Lot size <br /> Wafer Supply: Public system E] Community system El Privafe�Depfh to Wafer Table ft. <br /> Character of soil to a depth of 3 feet: Sand 0 Gravel 0 Sandy Loam F-1 Clay Loam Clay 0 Adobe E] Har.dpan 0 <br /> Previous Application Made: Yes E] No New Construction: Yes [-] 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 /> El No. of compartments--------------------------Size--------------------------------Liquid depth---------- --------------Capacity---------- ----------- <br /> -------------- <br /> Disposal Field: Distance from nearest well-----_--------__Distance from foundation.-------------------Distance to nearest lot line------------- <br /> 0 Number olri'knes-----------------------------------Length of each line------------------------------Width of french <br /> ------------------ <br /> f filter material------------------------- <br /> ype or ---------Depth of filter material-----------------------Total length------------------------------------------ <br /> Distance to nearest well------------- <br /> e� � ---------Distance from foundation_-_.-..._-_-_-.-_.Distance to nearest lot line------------ <br /> N',mber of-pits----------------------Lining material-------------- ------- Size: Diameter-------------------- epth----- --------------------- <br /> �Ossv000l: Z!EL� <br /> Distance fi-orn nearest well--- __0 _4 <br /> - ---------- <br /> --- ---Distance from ougdation.-,--j Lining material--- <br /> 11,I <br /> Size: Diameter__15/A�0___­_16- ---------------- ---- quid Capacify_,___9,0 <br /> X 6 4 0---- -------gals. <br /> -,- — 4�_, - ---Distance from nearestwell-_-- A_ --- <br /> Privy; - ------------- --------------------------------Distance Tr-11 nearest building------------ --------------------- <br /> 0 Distance ;o nearest lot line--------- --------------------------------------------------------------------------------------------------------------------- <br /> and/or repairing cl scribe + <br /> 9 - - •4411 1 --------------- ----- <br /> .A ---- --- --------megni --- <br /> ----------------- <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, to I s, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)--- ------- --- ------- - -- -- -------------------------------------I-----------------------------.----(Owner and/or Contractor) <br /> By:--------------------------------------- <br /> ------------------------------------------------------------------------------------- -------------(Title)------------------------------------------------------------- <br /> (Plot plan, showing size of lot, location 'of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY-------------"- ------ --------------- - ------------------------------------------------------- DATE--------------------- <br /> R EV+EW-E­D=B-Y-:L--_' _ - --,;w -- - ------------------ <br /> DATE......... <br /> -- ------------ ---- ------ <br /> BUILDING PERMIT ISSUED----------------------------- -------�. DATE -------- <br /> Alterations and/or recommendations:------------------------ <br /> -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------­­­------------------------------------ <br /> ----------- ------------------------------------------------------------------------- --------------------------------------------------------------------------------------------- ---------------------------------------_ <br /> ---------------------------------------------­-------- <br /> -------------------------------------------------------------------------------------------------------------------------------------------- ----------------------- <br /> --------- -- --- <br /> --------------------------------- ---------------------------------- -- --- --- -- --------- - -------------------------------------------------------------------------------------------------------------------------- <br /> FINAL INSPECTION BY:..--------- <br /> ---------------- --------------------------------- Date---------- -- -.------------- <br /> W. —------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M 10-52 Revised W-2100 <br />