Laserfiche WebLink
APPLICATION FOR SANITATION PERMIT Permit <br /> (Complete in Duplicate) <br /> - Date Issued .....- -- <br /> Applica{ion 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;LOCA ION................ . ' <br /> -----------------••-•------------- - ---------------- --- ------------------- <br /> Owner's Name--------------------- <br /> ----------- ri <br /> ------------------------- <br /> Address <br /> -----Address--------- t l� Qi�/ti <br /> nn ,, C� <br /> Contractor's Name_.� ._t..�!i---•-- --- <br /> --- - ----T�"=- Phone D <br /> Installation will serve: Residence//[}Aartment House E] Commercial El Trailer Court ❑ Motel E) Other E]Number of living units: _J-.._ Nu ber of bedrooms o�7 Number of baths ../ Lot size -------------- <br /> Water Supply:` Public. system Community system ❑. Private ❑ Depth to Water Table 5 ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Er<arclpan ❑ <br /> Previous Application Made: Yes ❑ No' New Construction: Yes ❑: No Pa--' <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> F (No septic tank or cesspool permitted if ublic sewer is available within 200 feet.) <br /> � // <br /> Septic T k: Distance from nearest welvl...�........_...Distance from f n&a Jon---z--- ---�-----M f X. I.-.- ...` _ .._ <br /> IJo. of comparfiments..__..0 ---.--__---Size_�__...i��6.-._Liquid depth_---- --. �? Capacity--- <br /> -- <br /> Disposal eld: Distance from Weare t wellsP!-111--..�-Distance from foundation..�.d_1_------Distance to nearest lot line. ` -------• <br /> Number of lines---- _. Length of each line---1 .4 ------1-.--.Width of trench------ ---// <br /> Type of filter material. Depth of filter material._--- --------Total length.__---36 <br /> --------------------------------- <br /> Seeps -7Distance to nearest well ---Distanc om f.undation--- <br /> ......Dista�r�e to nearest lot line.... .......... <br /> Number of pits....... ..-..._ Lining material- .. Size: Diameter--. _..._ ' <br /> ---Depth_ -- <br /> - CR4 ------------------ <br /> Cesspool: Distance from nearest well-----------------Distance from.foundation----------.._-------Lining material----------- <br /> --. <br /> ---------- ---•- <br /> ❑ Size: Diameter--------------------------------------Depth_-------:---- --------------:-- Liquid Capacity gals. rr tt <br /> Privy: Distance from nearest-well- --------------z---------- "U <br /> Distance from nearest building.----------------------- --------------. r <br /> 171Distance to nearest lot <br /> Remodeling. and/or repair:ng (describe):--------- ----------- <br /> ------------------ <br /> ------------------------------------- <br /> ---------------•----------------------------------- <br /> a ------------•------------------------------- <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 /> ordinance fate laws, and rules and regulations of the an Joaquin Local Health District. ; <br /> (Signed]--6.1-1_—----- -----•,!!f,_ - -- ------ ----- Owner and/or Contractor <br /> By------------------- -- <br /> - - ------------••-----••--------(Tit e _. --- <br /> e-------------- .i <br /> (Plot plan, showing size of lot, location of system in relation t wells, buildings, efc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------------- <____5;::: -----------------------------------•---------•---------- DATE_ <br /> REVIEWED BYY� <br /> - - -----•-------------------- <br /> ------------------------------ - <br /> ------- DATE f <br /> U1LDING PERMIT ISSUED---------------------------- G--------�------ DATE----- ` <br /> ----- ------- --------- ---- <br /> Alterations and/or recommendations-__-_-------- � --------------`•------ " <br /> ........................................... ............. .. .-.--..-...._.._... ..,.- ..._. f.-.-.--- <br /> .. _-.......----._.... .. . .... .5.1.�.....1__5.1...---�/-�,. ... .. F- .......-------__------__-----.------------------------ <br /> ----------­-------------- <br /> -...................._ <br /> ... �. ./ P. .. ._. _l_r ... ......... .. .. ..... ... <br /> ......................................... <br /> 4 <br /> ..-------------..........-.._.-..--------_. ..-..---- .. . ....._.........-. _..__..-. <br /> FINAL INSPECTION BY:.--- ------------------- <br /> Date.. .� <br /> ----------- ------- <br /> SAN JOAQUIN LOCAL HEALTH_ DISTRICT f <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 /> E5-9 145446 ATWOOO <br />