Laserfiche WebLink
APPLICATION FOR SANITATION PERMITPermit No. ...4P_ <br /> -..... <br /> (Complete in Duplicate) <br /> Date Issued ___ � s <br /> Applica{ion 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. 549. <br /> JOB ADDRESS AND LOCATION___.`._`'` -vim-__-------- --- #` <br /> -•----•*----^------------ <br /> Owner's Name- <br /> - -:---- Phone <br /> Address------------ i p <br /> �r ----------- --------••---------------------------------•-•-----------------------------�---•------------/------------- <br /> Contractor's Name.... f on <br /> _. - ----•------------------=••----------------•.---- Ph e _ A- -4p <br /> 11 <br /> --- --- - --- --- <br /> Installation will serve: Residence House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: --f_--- Number of bedrooms Number of baths _1---. Lot size <br /> ( Wafer Supply: Public system n—C-0mmunity 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 6�Hardpan ❑ <br /> Previous Application Made: Yes ❑ No. -New Construction: Yes ❑ No 6__ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if p��u''blic sewer_is available within 200 feet.) <br /> nSepjic TaXk: Distance from nearest well-,'/0 Distance from foundation------------_-------Material------------ <br /> .,______________-_____________- <br /> No, of compartments Size Liquid depth CapacitY-----------•----------- ~ <br /> Disposal Field: Distance from nearest weIIG.? C--Distance from foundation----A?.........Distance to nearest lot line__/_�E.*____ ) <br /> �`� Number of lines----------------- -r---------Length of each line_---,2,,�A_------------Width of french-- r` ''---•------------- / <br /> Type of filter material__ _�--------------Depth of filter material------/9..'_-_.Total length---------247 - - <br /> Seepage Pit: Distance to nearest well- inE_Distance rom, fo�ndation____�Q-t------Distance to nearest lot line-_/0--11 _ <br /> Number of pits--------f--- -------Lining mate ria l__-_-Size: Diamefer___ -2 r--------Depth' -- <br /> -------------------- <br /> -------- <br /> Cesspool: Distance from nearest well----_------------Distance from foundation <br /> ------------_-------Lining material___----------------------------------- <br /> Size: <br /> _-____-.__-________________ ---Size: Diameter-------- ------------------------.---.Depth - Liquid Capacity---------------------------gals. <br /> - --------- - <br /> dPrivy: Distance from nearest well--------------------------_---------------------Distance from nearest building <br /> ❑ Distance to nearest lot line-----------------------------------------------------__-------- <br /> Remodeling and/or repairing (describe):---------- _______________ ____`-:__-__.- <br /> -----•----------- ----• ------------- <br /> ------------------------------------------------ <br /> •---------------- <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, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> P- <br /> (Signed)------ ------ <br /> .. --• -------•- --- -- -- ----------- --------I-------- ----------•--------- ----------••-------------------------- rae Contracto`) <br /> By: - -- :--- ---------------------------------- ---------------------------------------------(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 BY---------------------------------------- -------------------------------------------------------- DATE---------- <br /> REVIEWEDSY---------------------------------------------------------------------------------------------------------- ------ DATE <br /> iIN PERMIT ISSUED---------------------------------- -------------- -----------------------------•-------------------- DATE------ <br /> Alterationsand/or recommendations----------------------------------------------_ <br /> ------------- <br /> - -------------------------------------'••--------------------------------------------•------------------ --- ---­----------------- <br /> --------------------------------------------------------------------------- -------------------------- --•--------------------------------------------------------- <br /> FINAL INSPECTION BY:--------- <br /> -----------•--- Date._. 5 ~ <br /> ------------------------------- <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 145446 ATWOOD 12-54 <br />