Laserfiche WebLink
APPLICATION FOR SANITATION PERMIT Permit No. .-.0-_©_4.V.. 1 <br /> (Complete in Duplicate) <br /> Date Issued ------��."...�_-� <br /> Applical-ion is hereby made to the Sari 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 A LO ATI '! - v------------------------------ <br /> Owner's Name 4 --- --• -•--------•--- --- <br /> ------------ Phone-------------------------------•--- <br /> Acl&ess------------------- ­- --- ----------------f---------------------- ---------------- ----- ---------------------------------------------------------------------------•----------------- -- <br /> ii�� moi.`-, <br /> Contractors Name.. ---------IT_��{ 1 C� Phone 1 <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ , <br /> Number of living units: --- Number Number of bedrooms_ Number of baths --/-- Lot size _-----_-�--/ �------------------------------------------ <br /> Water <br /> . `—.................... <br /> Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table rite ft. { <br /> Character of soil to a depth of 3 feet: Sand ❑. Gravel ❑ Sandy Loam ❑ Clay Loam Clay E] Adobe ardpan <br /> Previous Application Made: Yes E] No P--"New Construction: Yes ❑ No �❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> I� <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> if <br /> r <br /> Septic T k: Distance from nearest wells-0-----_-Distance rffrom founndation_ -- .0---_---..Mwateri`f--___.-_____--------------------_-- - <br /> No. of compartments------- "'Y_36. depth--S._-7---- - --Capacity-_ <br /> � u <br /> Dispo I field: Distance from nearest well-------------- Disfan e tr•om foundation-___-_--_---------Distance to nearest lot line----------------- <br /> Number of lines-------------------------------.__Length of each line------------------------------Width of trench--_- ------------ - <br /> Type of filter material-------------------------Depth of filter material------ Total length---------------------- ----- <br /> Seepage it: Distance to nearest well.f ._-_----Distanc om oundation_- -------------.Dist ce to nearest lot��1..'llrr--- -----_------` <br /> Number of pits----- -------------Lining material__ Sizer biameter_ f ---.Depth-. J__ ,i <br /> } �. <br /> Cesspool: Distance from nearest well-------------_--Distance from foundation------------------_.Lining material-------------------------------------- <br /> El Size: Diameter ------------------------- - ------Depth----------- ----------------- ----------------------Liquid Capacity-----------------------------gals. <br /> Privy: Distance from nearest well----------------------------------------- ---Distance from nearest building------------------------------------------ 1 <br /> ❑ Distance to nearest lot line-- --------------------------•------ -----------------•-•---------------•--------- ------------ ---------------- <br /> Remod linjadd/or r airing (descril�e): - ----- ---- --•--`----•---- -- ------ ----- <br /> -------— <br /> E <br /> -------------- --------------- <br /> ----------- <br /> ----------------------------------- ----- ------------------------------------------ ----------------------------•• ------------------------------------------------------------------------------------------------- <br /> I hereby certify t at 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 /> - - <br /> f <br /> (Signed)------------------------------------------------------------------------------------ ---- - Contractor) <br /> By:---------------------------------------- ---------- -•-------------------------------- <br /> (Plot plan, showing size of lot, location of system in relation t wells, buildings, etc• ------(Title)-can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--- ------------------ ---------- -- --------------------------- ----------- DATE-----------f__ -/ sc-^�r/ <br /> REVIEWEDBY--------------------------------------=------------- -- - --- - --------------------------------- DATE ----- - -------------- <br /> BUILDINGPERMIT ISSUED--------------- --------------- --------------------------------------------------------------------- DATE--- -------------------- ----------------------- ----------- <br /> Alterationsand/or recommendations:--.--•... .......... ------------------- --•----------------•---•-----------•-----•----- ---------------------------•---•-•----------------------------- <br /> ----------------------------------------------------- ------------------------------------- ------------------•-•--------------------------------•----------. ---.--- -------------•-------------------------------•--•---- <br /> FINAL INSPECTION $Y::' € --------------- Date.... -5" --------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Sfree+ 814 North "C" Street r <br /> Stockfon, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M 145446 ATWOOD 12-54 r <br />