Laserfiche WebLink
APPLICATION FOR SANITATION PERMIT 4 Permit No. _ _ __ .. <br /> (Complete in Duplicate) Date Issued - <br /> V# District for permit to construct and install the work herein described. <br /> .Application 1s hereby made to the San Joaquin Local Health <br /> This application is made in compliance with County Ordinance No. 549. <br /> --------------------------------------------------- <br /> JOB ADDRESS AND LOCATION---------------- ------ <br /> Owner's Name--------------------------------------------- ~ ----- ------1f ------------------------------------------------ Phone_-a--3--1--3-cl-7------------ <br /> ---------------------------------------------- <br /> Address ------ ----------------------- -------------------- <br /> = a ' "I---•------`--`--' Phone �- '-GQ` ;. <br /> Contractor's Name--------------_------------------� '� <br /> Installation will serve: Residence IN Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _-/__ Number of bedrooms _-Y_ Number of baths __J_- Lot size __ _-__ -_ -s- ?-------------------- ----- <br /> Water Supply: Public system,❑ Community system '❑ Private 1K Depth to Wafer Table _� ftOP1 <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe`, ; Hardpan , <br /> L Previous Application Made: Yes ❑ No tg, New Construction: Yes ❑ No ❑ a � a- <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> S tic Tank: Disfance from nearest well_________________Distance from foundation--------.----------.Material------------------------------------.---__------ <br /> '` �Z:;--p f--7. No. of compartments------ ------------------Size-------------------•-----------Liquid depth--------------------------Capacity--------------------- �-j <br /> Disposal Field: Distance from nearest well_------ <br /> Distance from foundatiog--�,?` <br /> ---------Distance to nearest lot line_. ____ <br /> Number of lines------- ----------------------- Length of each line---__to --_'------------Width of trench------�-�-"--------.--.-- 'r�' <br /> _ Len -�� <br /> Type of filter material_-_-/_ --_Depth of filter material---l_g_111_-__ <br /> Total length Q -------- --- <br /> I Seepage Pit: Distance to neare t well-�1_d`--------Distant f foundation--- tarce to nearest lot lin`--- ------- <br /> Number <br /> a <br /> Number of pits--.-1_________________Lining materia!_ _-�_�_�_---Size: Diameter.__-- --:,�__-__r-___.Depth____ '_-_-_ _________ i <br /> Cesspool: Distance from nearest well-----------------Disfance-from foundation---------------.--- Lining material------------.--________________-___-_. <br /> ❑ Size: Diameter-------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well------_-----------------------------------------Distance from nearest building___._-.--.--:_____________-, _____- <br /> (] Distance to nearest lot line---------------------------------------------------------------------•-------- ------•--------------------•-•-------------------------------- i <br /> Remodelingand/or repairing (describe):----------------------------------------------•---------------------------------------••-----------------------•----•------------------=---•--- ` <br /> ------------ -• -----------­------- ---------....-_---------•---------------- -----------•---•----------------••--------------- - <br /> ------------------•--•------------------------------...........................------------------••----------•-•---•---------------•------------------•---------------------------------•-----------------=-------=----:--• <br /> E <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, State lq <br /> aKd rules and regulation-a San Joaquin Local Health District. <br /> (Signed = <br /> --------------- --�=- -----�--7 - +vr Contractor) <br /> ) ---- -Lt --------------(Title)-- -------,--, ------------------ <br /> - -Y---------------------------- <br /> 1 (Plot plan, shoaling size of lot, location of system�dn relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ----------------------------------- ----------------------------- --------- DATE - <br /> REVIEWED BY----------------------------------- <br /> ---------------- ----------- ------------------------------------ � <br /> BUILDINGPERMIT ISSUED----------------- - -- ------------------------------------- ------------------------------------- DATE <br /> I Alterations and/or recommendations_____________ <br /> . ---------------- - --------------------- ----------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> ------------------------------------------------=---------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ----------------------------------------------------------=-------- -------------------------------------- -- --------- ------------- ------------------------------ <br /> W--&7 <br /> / 4 <br /> 5 FINAL INSPECTION BY:------ (�_ ::--- --------------------------------- Date -*1'.`-�------------------------------------- <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 8-51 Revised W-2100 <br />