Laserfiche WebLink
4- <br /> APPLICATION FO R SANITATION PERMIT { <br /> (Complete in Duplicafaf <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 applicatio, is-made in compliance with County Ordinance No. 549 <br /> JOB ADDRESS ANY! LOCATION._- " � ' <br /> O {IllG..I'ci#t� <br /> Owner's Name - -------- --------------------------------- '---------------------------------= Phone <br /> Address --- <br /> --------------------------------' — <br /> `j <br /> Contractors Name-------------------=------------- •-- ----------------/-----,---------;------.---------------------------------•- ------------ Phone----------------------------- - <br /> Installation will serve: Residence [►Apartment House El Commercial Trailer Court ❑ Motel ❑ Other❑ <br /> Number of living units: A Number of bedrooms [� Number of baths ❑ Lot size________- <br /> i <br /> Water Supply: Public system Community system ❑ Private ❑ <br /> Character of soil to a depth Of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe e Hardpan ❑ 1(� <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: f ; <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Ir Septic ank: Distance from nearest well___��_____Distance from foundation____��..--------Material------------------------__________ __�__r_-____. <br /> No. of compartments_________:�__.--------Capacity-----------------------Size__�_X__/0------------Liquid depth-- ---�.__------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_____________________________________- <br /> ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------- <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ <br /> El Distance to nearest lot line________________________________________________ <br /> Seepage Pit: Distance to nearest weli----------------------Distance from foundation-------------------.Distance to nearest lot line--------.-__----. <br /> ❑ Number of pits----------------------Lining material-----------------------Size: Diameter------------------------Depth------------------.- <br /> i <br /> Disposa field- Distance from nearest well_____=___p____.Distance,frorrm=.foundat.ion_____y_f._.-:a:Distance{to.nearest_lot_lin _f>._:___.____. <br /> Number of lines_______________ Length of each line________.7s______________.Width of trench_______________ <br /> Type of filter material_----------------------Depth of filter material___________.___________ <br /> Remodeling and/or repairing (describe)-------_ __________________ <br /> --``-- ------------- - --'�-------° /-------- c---, ; -i��-----=------------------------------------- <br /> ----------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ----------------------------------------------------------------------- --------------------------------------------------------------•------------------------------•----------------------------------------------------- <br /> hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinance, State laws, and rules a regulations f the San Joaquin Local Health District. <br /> (Signed)-t <br />