Laserfiche WebLink
41 <br /> APPLICATION FOR SANITATION PERMIT Permit No. ... .. <br /> (Complete in Duplicate) <br /> Date Issued <br /> A <br /> ­ <br /> AppliLlion is hereby!-rade to the San Joaquin Local Health District for 6 permit to construct and install the work herein described. <br /> This application is maJe,in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND iLQC <br /> PT -----LP---------------- <br /> ---------- -------------_--------------- <br /> ------ .... <br /> Owner's Name----- <br /> -------------------------------------------------- <br /> if <br /> ----------- ---- ---------- Phone <br /> me :! ' <br /> - ------------ <br /> ------------ ----- ----------------------- <br /> Address__________________ <br /> ---------- I---------------------------------- <br /> Contractor's" -- <br /> -1-1y),---------- -------------- Phonel"o------ ? 0_7 <br /> Installation will serve:�� Residence 21"\Apartment House E] 'Commercial E] Trailer Court E] Motel E] Other <br /> El <br /> Number of. livin,g units: Number of bedroomsof baths.,t—___ Lot.size -------2� <br /> i - . - ---------------I---------- <br /> Water Supply: 'Public", system Community system E] 'Private [-I . Depth to Wafe'r'fable� ft. <br /> Character of soil to a,Aepth of 3 S <br /> Gra <br /> - ' El Gravel E] any Loam [:] Clay Loam"❑ Clay ❑ <br /> .i . feet: i Sand l d <br /> Adobe Hardpan E] <br /> Previous Application Made: Yes E] No New Co'n'stru'ct'ion: Yes No f <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank"or cesspool permitted if public sewer is a'vaila6lo' within 200 feet.) <br /> Septic Tank: Distance from nearest well--/VCIPt--'--Disfanc—e—fr-o"m fo_u_ndafj9n____./4>--------Material"___eZ_W_ --- -------7�M <br /> te <br /> N of'compartments-- <br /> ------- Size-74---e---,k!--- -Liquid depth---------- ----- ------ Capacity. -1/10 <br /> Disposal Field: Distance from nearest well-_-e�V_07L40istance from foundation-_/_!!��:,-, <br /> -.Distance to nearest lot line <br /> 'r1 0 _-,to­ <br /> -Number of fines----------/ <br /> -- -_----.Width of trench.--- <br /> Length of each line--------:��O------------ �--------- - <br /> Type of filter material-l-A 5 Depth of filter mate ria Total length------ <br /> X - ----- f ------------------------- <br /> Seepage Pit: Di4ance to nearest'well----A/ Dis-farce from ........D- 'is't a nge. to nearest lot iine--- <br /> N6'rriber of pits.------f-------- -------Lining mate'r;al--- ------------- <br /> --------------------- <br /> Distance stance., from nearest well----------I------Distance from foundation- -- ._..--- ---.Lining material------------------------------------- <br /> F1 Size: Diameter---------i------------------------ Depth- ----=----------- ------------- <br /> --------------------Liquid Capacity-------------------- ------gals. <br /> Privy: Distance from nearest well--------------------------------------------------Distance froO"nearesf building--_-.-.--------_-_-------------:---------- <br /> ❑ Dis'fance to nearest lot'iine.­ <br /> ----- ------------------------ --------------------------------------- . . .. <br /> --------------------------------------------- -------------------- Uj <br /> Remodeling and/or repairing (describe)---------- -- --- -- ---------------------------------------- <br /> ------------------------------------------------------------------------------------- <br /> ----------------------------------------------------------------------------------------------------------------------------- <br /> --------------------------------------------------------------------1­----­-------------- --------------­----------f------------------­-*---------------*-------------------:---------------------------------------- <br /> ------------------------------------------------------------- <br /> = ..-------•----- <br /> ----------------------------------------------------------------------------- ----------------------------------------- ------------------v <br /> Fhereby certify that I have prepared this and that the work will be done in accordance with San Joaquin County <br /> ordinances, Sgr tate ws, and rules and regulations of the-San Joaquin Lo�'al Health District. <br /> 2ev <br /> {Signed]_---------Pei! <br /> -------I- -------------------1----------------------------- Owner and/ <br /> Contractor) <br /> --------------------- <br /> BY:--- ------ <br /> ----------------------_(Title).... --------Z------------------- ---------- <br /> (Plot plan. showing SIZ61 of lot.' location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> AREPVPILEICWAETION ACCE <br /> PTED BY--------------=------- ------- --------------------------------------------- DATE------------C5;-7-7--7--_-�- <br /> --- --------------------------------- <br /> D BY------------- ': ---------------- - - ----------------------------- DATE <br /> --------- ------------------------- -BUILDINGPERMIT ISSUED -----I... DATE <br /> Alterations and/or-rec nmendafions:---------------------- - - <br /> ......... <br /> --------------I------------------------------------- ......%ki!� <br /> --------------------------------------- <br /> n7---------- ------------------ -------------------------------- <br /> --------------------------------------**----------------------------------------- ---------- <br /> ---------- <br /> ----------------------------------------------------------------------------------------------- --------:-------- <br /> 4 t, ------------- -------------------------------- -------------------------------------- <br /> ----------------­-------------------------- ----------------------------------------------- -----------------__7----------------------------i I <br /> -------------I-------------------------- ------------------ ---------------- -------------------- ---------••------- - -------•----------------------- <br /> - F <br /> ---------- --- --------- -------------------------------------------------------------------------- ----- <br /> FINAL <br /> -INSPECTIONS BY----- -------------------Z-------—_------- -------------- Date---- <br /> ­ ---------------------------------------- ----------- <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 Lod;, California Manteca, California Tracy, California <br /> ES-4-21v1 Revised W-2100 <br />