Laserfiche WebLink
f <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> • r t <br /> (Complete in Duplicate) <br /> Date Issued <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_. C------- ` -------- t_ - ___- <br /> --. <br /> ------------ Phone'---------------------------------- <br /> Owner's <br /> Name ---•----- <br /> Address-.---__--------------------------------------------------------------------------------- --- •... ---•--------•-------- <br /> Contrector's Name-------- ------------- � --- Phone---------_-----------------t-------- <br /> Installation will serve: Residence partment House ❑ Commercial ❑ Trailer Court E❑ Motel ❑ Other ❑ ; <br /> Number of living units: _------ Num bf bedrooms -- C tuber of baths _ ze --- --- Q_�C�_.---Qom _ - <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table ........ ft. . i <br /> Character of soil to a depth of 3 feet, Sand Gravel ❑ Sandy Loam ❑ ClayLoam ❑ Clay ❑ Adobe 0_44+iidpan'❑ <br /> Previous Application Made: Yes o ❑, New Construction: Yes g-11 U " _ i <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: ( l <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> S tic T nk:r Distance from nearest well----------- -----Distance from foundation.................._Material-_---_- __-.-_-'.-----..__---.______--------. <br /> No. of compartments------ ---------- Size-------------------------------Liquid cieRf ------------------•------"Capacity---------------------- <br /> . <br /> Disposal Field: Distance from nearest! well__ __#7W_1stance from founds on.- -_ -- .-.-.Distance to nearest lot Ime-- <br /> Number of lines-- 1-----_ ---- Length of each line-- 7-" r-----.Width of trench._-_f.-" =�� <br /> Type of filter material-�T <_-.De th of filter material ----...-°-----Total length--:--.--- .�[? <br /> p <br /> Seepage Pit: Distance to nearest;well______ _____________Distance from foundation------------- wl <br /> ------- to nearest lot line----------------- <br /> Seepage <br /> Number of pits.----- '------------Lining material-----------------------Size:'Diameter----.-_------------ Depth-------------------.__----------- <br /> t. <br /> Cesspool: Distance from nearest well-----------------Distance from foundation.--.---------f-----Lining material-------------------------------------- <br /> ❑. r•'` -µ Size Diameter . - *Depth _-_.-------_--- ,----_ -----Liquid Capacity gals. <br /> Privy:; Distancefrom nearest well-------------------------------------------------Distance from nearest building --------- <br /> ❑ Distanceto nearest lot line------------------ - .. ------------------------------------ ---------------------------------------------------------- <br /> Remodeling and/or repairing.(describe) --------------------------------------_=---------- -----------------------------------------•-- -----•------------------•--------- ---•----•-----••- <br /> 1 <br /> ----------4'-------------------------------------------------------------------- -----•----------------...............».._..•-----------•---------_.....---------•-----------_...----••-•----^--•--------------------------- <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. i k <br /> a �^ ' _Owner and/or Contractor <br /> (Signed)--- <br /> � <br /> IBY. ---- -- --- ----- r - - ------------`-------- = (Title) <br /> (Plot plan, showing size of lot, location of ystem in relation to wells, buildings, etc.; can be placed on reverse side).' <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY DATE ------_. .----------------------- <br /> REVIEWED <br /> --- <br /> ----------------- <br /> REVIEWEDBY ------------------------------------°`-------------------------------------- DATE------------------------------------------------------------ <br /> BUILDINGPERMIT.ISSUED------------------------------------------------------------------ --------------------------------- DATE------ --------------------------------------------------- <br /> ------------- <br /> •-• ----- -- ._ <br /> - - ------------------- <br /> Alterations and/or-recommendations------------------------- ! <br /> --------------- ----------------------------------------------------------------------------------------•-------•----------- <br /> --------------------------------------------------------­-------------------- ---•---------------•---------------------------------------------------------------------•--------------------------------------------------- <br /> ------------- <br /> } <br /> --------------------------------- ---------------------------------=---------•----------------•-- • -------•-•----------------------------------------------------------------------------------------------------------- <br /> FINAL- INSPECTION BY:---------- -----•---------- ----•-----------------„ Date---- ------ � ----. <br /> SAN <br /> 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 ; IRevised W-2100 <br />