Laserfiche WebLink
APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicafe) <br /> Date Issued .... <br /> Applica-lion is hereby made to the San Joaquin Local Health Districf for a,permit to construct and install the work herein described. <br /> This application is made incompliance with County Ordinance ho 549tr <br /> JOB ADDRESS AND LOCATION----- r ----- — -------------------------------- <br /> JOB <br /> Name--- --------�_ ----------..... ------------- - - - - --------------- -Phone ' <br /> Address________________` <br /> ZContractor's Name_ I ----------- ,... _rrs._----------------------------------•---------------------- Phone 1 <br /> Installation will serve: Residence partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -1---- Number of bedrooms _.Number of baths/----- Lot size ___ "— <br /> Water Supply: Public system arr=munity 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 n ❑ <br /> Previous Application Made: Yes ❑ No4-19—el—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 Tan{;� Distance from nearest well__;--------------Distance from foundation__.________.______.Material-_--:_.-_--______._-___-___-.._...___....__-_._. <br /> No. of'.compartments--------------------- ----Size--------------------------------Liquid depth -------------- .--,--'.-Capacity----------------------- <br /> Disposal F1 Id: Distance from nearest well---------------1 Distance from foundation----------------'_.Distance:to nearest lot line----------------- <br /> " -----Length of each line__}- Tri-' - ----._.Width of,trench------------------------ <br /> Number of lines------------------------------ ----------- <br /> Type of filter material-------------------------Depth of filter ma�ter.ial_ .-__---.--_-___.Total length------------------------------------------ <br /> Seepage Pit: Distance to nearest well ` _'Distance from fou'dation__..__�-d__'..Distan te�.to nearest lot line_./V_____ <br /> Number of pits------/............Lining mate ria l__, _Size: Diameter-----__;?3;___:----Depth----- ^____________ <br /> Cesspool: Distance from nearest well----------------- from foundation,`-_------`-------Lining material-----------------___------------------ <br /> - <br /> ----------------- gals.Size: Diameter------------------------- -----De Depth------------------------------ " ..._Liquid Ca acitY <br /> Privy: Distance from nearest well-----------------------------_-------------------Distance from nearest building-------------r- ---..----. ---__-___.___. <br /> ❑ Distance to nearest lot line---- ---- --------------------------------------•--------------------------------------------------------------------------------------------- <br /> Remodeling and/or repairing (describe)--------------------------------------------------------------------------------------------------•------------ ------------------------- ._...,----•---- <br /> ---------------------------------------- <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, St ,, nd r s and re uI fions of he San Joaquin Local Health District. <br /> {Signed} ---- -- ----------- -- - , ✓f/`` tractorl <br /> BY: '6 {Title A �-- <br /> ... . -------------------- )--. --- --------- <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 /> APPLICATIONACCEPTEQ BY--------------------- - --------------------• -••----------------------------._ DATE. ------------------------------ <br /> REVIEWED BY------ <br /> - <br /> - DATE---------------` <br /> - -BUILDING PERMIT ISSUED---------------------- -------- -- --------•---------- ---- ----------------------------- DATE------------ ------ <br /> ---Alterations and/or recommendations: -1�11► <br /> --------------------------•------------------------------------------------ -----------------••---------------------------.--------------------- -------- - ----- "�--------------- <br /> -------------------------- <br /> ------------------------------ ----------------- --------- <br /> ----- ----------.--------- •-- <br /> ---- ------- -------- -------------------- --------------•-- --------------- --------------------------------------- ---------------------- -------------- <br /> FINAL INSPECTION BY:. ------------------ -------------- Date. ----------­•r------J�l <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 145445 ATW09D 12-54 <br />