Laserfiche WebLink
r APPLICATION FOR SANITATION PERMIT Permit No. ..... <br /> _l..." <br /> (Complete in Duplicate) %X_Date Issued __- <br /> Applica4,ion is hereby made to the San Joaquin Local Health District for arpermit to construct and inst Il the work herein descr-bed!1 <br /> This application is made in compliance with County Ordinance No: 549. <br /> JOB ADDRESS ANDAaT�ION-�-_ #- <br /> me <br /> " . <br /> °'.��'i�'_Owner' NaE 3-- - - ------------ <br /> -=-•--- -•-- - Phone----- <br /> Address---- - ---1---- ------Contractor's Name---- <br /> �-�,.---- --�----- - ------ - -------------- - Phone..__. _.=/��.J <br /> Installation will serve: Residence Apartment House ❑ Commercial <br /> El Trailer Court E] Motel Other ❑ <br /> Number of living unifs�_\Number of bedrooms_._ Number of baths ":, Lot size _. <br /> / ------- <br /> Water Supply: Public system ❑ Community system ❑ Privatex Depth to Water Table_,gs ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan <br /> Previous Application Made: Yes ❑ No New Construc4on: Yes No F-1 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) l <br /> Septic Tank: Distance from nearest well--� f Distance f-r-om foundation-",-11 -----Material _�� <br /> —"No: of com artments-_ IF <br /> CS- --------- ------ Liquid depth — Ca Capacity---------gOo <br /> b' <br /> Disposal Field: Distance from5eare wail__-��- _Distance foundationNumber of lines <br /> ------Length each line - --------Distance to nearest lot line_____ <br /> of french_-__ ' <br /> Type or filter materi a ------------ <br /> _ _-__-___Depth of filter materia__-�_-�_�__"""_Total length---------- �- <br /> Seepage Pit: Distance to nearest weft 4p-"� Distance fr , four;,ation --------Distance to Weare <br /> Number of pits----- _Linin material__-. � �f 1 <br /> g s ---� ..-Size: Diameter- --------- - e / <br /> Cesspool: Distance from nearest well______"___"__--_Distance from foundation__.__--______-__.-. rng material__: l�, y d+ 1 <br /> ,. <br /> �. =0 - Srze:�Diameter, __,-, Depths -.--- Li. uid_Ca aci <br /> -. ------------ ---------""-- " g l <br /> . _____.________._.-_DistanA�e f m nearest building <br /> ty <br /> Privy: Distance from nearest well <br /> al <br /> El Distance to nearest lot line"__::- <br /> � " <br /> Remodeling and/or repairing (describe]:___--__' <br /> ---------------------------------------------- <br /> ---------- ---------------------- <br /> ------------------------------•--------s---•--------•--------_------------•--------------- i------•----- - -.-- ----- <br /> j�Jj - <br /> ----•-------------- -------_____-__-_-________ <br /> " 1 - ----------------_----- ---------- <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 I s,' n r a regulations of the San Joaquin Local Health District. <br /> (Signed)---------------- - ---------------------' <br /> $y:------------------- <br /> t -- ------ Owner-and or,Contractor) <br /> - ----------------- ---------------------------------------------(Ti#Ie), `��`' �✓;_ __ <br /> — =r• T <br /> (Plot plan, showing size}o Idf, location of system in relation to wells, buildings, etc., can be plate on reverse srde). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY' ---- i <br /> DATE, _ <br /> I WEDREVBY---•------------------------------ DATE�"__ <br /> - ---------------------•--------------------------•-----------• .__---------------------------------------•----- -= <br /> BUILDING PERMIT ISSUED :-- ----- - <br /> DATE -\------------ -- <br /> Alterations and/or recommendations: <br /> ---------------- <br /> ------------------------------------ -------------------------------------- <br /> -------------------------------------- ---------- ------------•----- <br /> ---------- --------------•---- <br /> ------------------------------------ <br /> -•------•------------------------------------------ <br /> ---------------­------- ------ <br /> FINAL INSPECTION -- -------- ----- <br /> ---- --- ---------------- ---------•- Date------- --------- ----------------- <br /> -------------/--------------------- - <br /> SAN JOAQUIN LOCAL HEA H_,D�STRICT - <br /> 130 South American Street 300 West Oak Streef 132 Sycamore Street 814 North "C" Sfreef <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M Revised W-2100 f <br />