Laserfiche WebLink
FOR OFFICE USE: <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 Ordinance No. E)�.aj <br /> ccJOBADDRESS AND LOCAT ON---- -- ----- - --------l- --- .......M-Owner'sName------- <br /> Address <br /> -�� . __�... .. ,.. <br /> ------------------------------------------------------------------- <br /> Phone Q. _ .1..1 i <br /> Address--------• �� --- --- -- -- ,' ----------- <br /> Contractor's Name-------- - - s Phone.... <br /> Installation will serve: Residence partment House,❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _�.... Num of bedrooms--2-Number of baths ._,<... Lot size _... _. __�d__�....................... <br /> Water Supplly:"Public-system" ommu'nity'system❑' Private'❑ 'Depth to Wlater'Table.#._-. ft.- d <br /> s <br /> Character of soil to a depth of 3 feet: I Sand El Gravel C] Sandy Loam E] Clay loam ❑ Clay E] Adobe' ardpan C]Previous Application Made: (if yes,date----'---------------) No ew Constru Ftion: Yes ❑ No �VA:Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> 4 , <br /> Septic Tank f - Distance from nearest well.................Distance from foundation....................Material------------------------------------------------- <br /> ❑' No. of compartments--------------------------Size.-------------------- .....,*.Liqui depth--------------------------Capacity------------........... <br /> Disposal Field: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line................. <br /> ❑ t Number of lines...._I._.-._....- Length.of,each line_._".._--I..I.............Width of trench----------------------------------- <br /> �� Type of filter material..k..----- ----_Depth of filter material:---I._.`-------------Total length----------------------................. <br /> ... <br /> Seepage Distance to nearest well----_._._.____`.....Distance from fou ation e-'distance to nearest lot line- <br /> Number <br /> _..... ` <br /> Number of pits------ -:-•--___-- g ze: Diameter----- /�------Depth----.� ------------------ <br /> Cesspool: <br /> -.- <br /> Cess ool: Distance from nearest,well-----------------Distance from founds <br /> ..Limn materia.._ - i <br /> p � � foundation.-'.---i--------------Lining material------------------------------------- <br /> El <br /> Distance De fete nes - I-'--t---`-----"--.. ...Depth----.------- •......._.... ------------Liquid Capacity............................gals. <br /> Priv <br /> well-..... ......... --..----------_.. <br /> . - I_.-...Distance from nearest building <br /> - <br /> Privy- <br /> r1 : --• ---------------- ----------------------- <br /> ❑ Distance.to nearest4lot line--------------------------------------- <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)_ ..)x/t,:)_-_. f{ __ ._ --- ----------- = (Owner end/or Contractor) <br /> By---------------------------- ff --------------------= (trial----------------------------------------------- <br /> ------------ -- -------�---•--------------------------------------------- t ----------------- <br /> (Plot plan, showing size of lot;location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> L I FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY �f - ------ -- ._.._ DATE - .C-- ------ _. -------- <br /> -- --------- <br /> REVIEWEDBy-------------------------------------------------- --------------------------------------------------­-------- -- DATE-----------------••----------- <br /> BUILDING`PERMIT ISSUED {----------------------------------------------------- ----------.-. DATE----•---------------.....-._..-.------------------....... <br /> � T r <br /> Alterot'ons and or recom a ations: ---------'-------------------------- - r -------------------------------------------- --- - -- ----------------.. <br /> a . <br /> t <br /> --------- - <br /> L�1 <br /> h <br /> FINAL INSPECTION BY:.. /` ---- -- -' <br /> Y...r <br /> Date------_7-`.- - -----------�-------,- <br /> --------------------------------- <br /> 2SAN-JOAQUIN <br /> LOCAL HEALTH DISTRICT <br /> +� <br /> 130 South American Street 1300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> r <br /> Stockton,California ,,.Lodir California Manteca,California Tracy,California <br /> EB 9 AEVIsEo a-99 aM 5-61 ATLAS <br />