Laserfiche WebLink
7 � ,� s� <br /> APPLICATION FOR SANITATION PERMIT Permit No. ------ <br /> (Complete in Duplicate) Date Issued.____/.3_��___ <br /> Aplica-�ion is.hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This <br /> application is made incompliance with County Ordinance.No. 549. <br /> -------------------- <br /> JOB ADDRESS AND LOCATION.,&_.: <br /> ---------------------. Phon <br /> Owner's )L %.:F T 7 <br /> -------------------------------------------------------------------- <br /> Addressy------ ZaL._�--- -,/ <br /> Contractor's Name - <br /> -------------------------------- -- ----------I--- Phone----------------------------------- <br /> ------------- ----------------------------------------- ----------------------------------------- <br /> Installation will serve: Residence Apartment House E] Commercial E] Trailer Court L] Motel 0 Other <br /> — e72 a <br /> Number of living units: Number of bedrooms _a._ Number of baths A---. Lot size ZT-A-A......Ite---- ------------------- <br /> Water Supply: Public system 0 Community system E] Private K Depth to Wafer Table /0-- ff. <br /> Character of soil to a depth of 3 feet: �Sand El 'Gravel [] Sandy Loam E] Ciay Loam4- Clay E] Adobe F] Hardpan E] <br /> Previous Application Made: Yes E] No gj New Construction: Ye.5;K No E] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well__.-_-__Disfance from foundation---/0----------Mafe,rial_/%4 <br /> No. of compartments--------Q--------------Sizedx__S__X---17 1-------Liquid ciepth------y------------------Capacity---- <br /> Disposal Field: Distance from nearest well--9-0........Distance from foundation-----1 __-____._.Distance to nearest lot line____,_-_____ <br /> Number <br /> ine----5 1------ <br /> Number of lines--------Z----------------------Length of each line--------4-D-_-------------Width of trench------a------------------------ <br /> 0 <br /> Type A T filter material---e0fk----------Depth of filter rnafenal---JZ............Total length----- --------------------- <br /> Seepage Pit. Distance to nearest well----------------------Distance from foundation--------------------Dista' nce to nearest.lot,line----------------- <br /> 171 Number of pits----------------------Lining material-----------------------Size: Diameter------------------ ----Depth- _-- -------------------------- <br /> Cesspool, Dis'tance from nearest well-----------------Distance from founclaf-icn.---------------------Lining material__________.-_______.______-____--_. <br /> ❑ <br /> aterial------------------------------------- <br /> El Size. Diameter_-------------- -------- - --------Depth-------------------------------------------------.--Liquid Capacity-------- ------------------•gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_______________________________._ <br /> ❑ Distance <br /> uilding----------------------------------Distance to nearest lot line--------------------------------------------------------------------------------------------------------------------I------------------------ <br /> Remodeling,and/or repairing (describe):------------------------- -—-------------------------------------------------------------------------------------------------------------------- <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, State laws,and rules and regulations of the San Joaquin Local Health District. <br /> (Signed}_..-_(10__J_0�_�__ ----- --- __/---------------------- ------(Owner and/or Contractor) <br /> By:------------------------------------------------------------------------------------z ----------------- --------- <br /> (Plot <br /> (Title)----- <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 <br /> BY__�_ --------- --------------------------- <br /> -----------------------__---------------------------------------- DATE ------------------------------------------------------------------- <br /> - <br /> REVIEWEDBY------- --------------- --- DATE-- ---------------------- — ----- <br /> BUILDING PERMIT - ---- DATE____r -------------------------------------------- <br /> Alterationsand/or recommendations-------------------- ------ ------------------------------;------------------------------------------- ------------------------------------I—------ <br /> --------------------------------------------------------------------- -------------------------------------- ----------------------------------------------------------------------------------------------------------------- <br /> --------------------------------------------------------- ------ ------------------------------ ---------------------------------------------------------------------------------------------------------------------- <br /> ----------------------------- ----------------------------------------------------------------- ---I------------------------------------------------------------ ------------------- --------------I I----------I�-- ------- <br /> -----------------------------------------------------------------­­--------------------------------------------------------------------- <br /> FINAL INSPECTION BY:------ ---- ------------------------------------------ <br /> Dat ------ --------------------- ------ ------------------------- <br /> - - -- --- ---- ----------------------- <br /> --------- <br /> _�NOAQUIN 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 /> ti <br /> ES-9-2M Revised W-2100 <br />