Laserfiche WebLink
FOR OFFICEUSE ,C <br /> ---��� �--, ---- j <br /> ---_-- _ __.____._ APPLICATION FOR SANITATION PERMIT Permit No. .../....����.� <br /> ----------- ------------------------------------------- (Complete in Duplicate) <br /> Date Issued <br /> --------------------------------------------------------- This Permit Expires 1 Year From Date Issued <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 Ordi nce No 49. <br /> JOB ADDRESS AND CATION.... 17 .. <br /> Owner's Name..----.E ......... <br /> •-- -----------------------------•----- Phone------------------------•-- <br /> Address..................... ........ . <br /> ---- 5.........--------.. -•----•..................••-----........._...-----------•----•-•----------------------------------- ._.. <br /> Contractor's Name..... ....... ........,__ --- .._.- Phone................................... <br /> Installa+ion will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ___I___ Number of bedrooms _ __ Number of baths ..1_ Lot size -- O _._. --------------------------- <br /> Water <br /> ------------------ ---Water Supply: Public system ❑—tommunity system ❑ Private ❑ Depth to Water Table ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe(��rlardpan ❑ <br /> Previous Application Made: (If yes,dote--------------------) No Ej'/ New Construction: Yes ff"'No ❑ FHA/VA: Yes ❑ No (5— <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> S?ptigWpl <br /> Tank- Distance from nearest well_________________Distance from foundation....................Material................................................. <br /> No. of compartments--------------------------Size--------------------------------Liquid depth__......------ ---------Capacity.......•----••......... <br /> Disp dal Ft 4d: Distance from nearest well_________________Distance from foundation..___--._______..__-Distance to nearest lot line................. <br /> v r c. <br /> Number of lines___._.t_._..__���_______Length of each line_�0____-______�_-____-.Width of trench---Zk_ _____________________ <br /> Type of filter ----Depth of filter material-----/$- -------Total length........ ______________ <br /> f r <br /> Seepage Pit: Distance to nearest well .------Distant fo ndation_,bd.___........Distance to nearest lot line-.`.5.�..._.... <br /> Number of pits............ __Lining material____ --.Size: Diameter._-3.3_ -_ <br /> --- - - •�---•---.Depth---------•--rf---'--`�---------- <br /> Cesspool: Distance from nearest well-----------------Distance 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-----------------------------------------------------------------------------------•-----•-------•-------------------------------------------- <br /> Remodeling and/or repairing (describe):-------------------------------------- --------•----•---------------------•-------••---------•-----•----•--------------•---------------•-••---------•--- <br /> t -----------------•----------------------------------------•---•----------------------------------------------------•-•-------.._....---••------••--------•---------•--.........-------------------------------------------- <br /> ------•---•-•---------------------- --------- -- ---------------•-------------------------------------•-•---------•-•-----------•--------------------------------- •----•---•---.....-------•--------------------------- \ <br /> I hereby certify that I s Or ared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, a les d regulations of the San Joaquin Local Health District. <br /> (Signed) . ..---------•------=-------------------------------------------------------------------------------------------------(Owner and/or Contractor <br /> BY: --------- -------•-------- -----------(rifle)---------------------------------------------------------------- <br /> (Plot <br /> --------(rtle)....-------------•------------------ <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 /> APPLICATION ACCEPTED BY 1. � ---••---------------------- DATE---- --- -• -------------- <br /> REVIEWEDBY----------------------------------------------------------------------------------------------•---_---------------------- DATE E ----- <br /> BUILDINGPERMIT ISSUED_..............------------------------------------------------------------------------------------- DATE---------------------••--•---------------------------------- <br /> Alterations and/or recommendations:-------------------------- ---------- ----------------------------------•-•-----......---•-------.._._..-------------•-••------------------------------- <br /> ---••----•---------------------------------------------------• ---------------------------------------------------------------------- -----•-------------- <br /> ---------------------_...------------------ ---------•--•---•-- ------ -------------------------------..._..-•------------- <br /> FINAL INSPECTION BY:... �--- Date---------Y�-- ----�- ------- ......... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Serol 144 Sycamore Street 205 Wast 91h street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> CO 9 REVISED 8-59 EM 5-61 ATLAS <br />