Laserfiche WebLink
APPLICATION FOR-SANITATION PERMIT � .'�� Permit No. 1 '�.-•- <br /> (Complete in Duplicate) <br /> �� �S� <br /> e Issued ---• -_ <br /> Applica4-ion is hereby made to the San Joaquin Local Health District for a permit to construct and iyns Sl the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. l <br /> JOB ADDRESS AND LOCATION-------------- -----------� --------- -- -"----------- -------------------------- •---------------------------- <br /> ----------------p----•---- <br /> ------------ <br /> Phone. '".Owner's - <br /> Address--- -----_- ------ a 7*� <br /> ------ -----------—-----------------------• ------------------------------- -- -------------------------- <br /> --- <br /> ------------ 0 - / <br /> ---- ------- <br /> Contractor's Name------ 0--<-"------?----------- � Phone � .. . <br /> n <br /> Installation will serve: Residence JS Apartment Hous 'Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living unjfs-: _ __ Number"of bedrooms--U./Number of baths AF—Lot s ---------------------- <br /> Water <br /> ze.._-- -_(✓___. _ ��� ---------------Water Supply: Public system 0 Community system ❑ Private ❑ Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet:l ,� Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: Yes ❑ 'N6--El- New'Construction.—Yes N- No ❑ - <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: - <br /> No se tic.tank or cesspool permitted if public sewer is available within 2d0 feet.) <br /> Septic Tank: Distance from nearest well Lee ---Distancefrom foundation- ___ Material------ -c ` <br /> No. of compartments------------- f; Li uid depth �._. _ ___'Capacify _--- --- ----"' <br /> �__-_Distance from foundation_.._../a---------Distance to nearest lot line----------------- <br /> Disposal Field: Distance from nearest well_._��-_-- /f <br /> Number of lines----------�--------------- ---LLength of each line-------�O'-------------Width of trench.-----. - ----:-------------- <br /> x Type-of material- Act h Depth of filter material----------W_.__ Total length--------------- -- ------------------ <br /> Seepage Pit: Distance to nearest well------__--------------Distance from foundation`"::----------------- Distance to nearest lot line----------------- <br /> ❑ Number of pits ----- '= Lining material----- -----------------Size: Diameter----------------•`=----Depth:-.,,--------------------- --••-- <br /> Cesspool: Distance from nearest well_A_-__-:---------Distance from foundation___-----------------Lining material.... ------------_.--------____-___ <br /> #__- .,. �.;. liquid Capacity gals. <br /> ❑ Size: Diameter------------- ------- ".- Depth-n :- _. = - <br /> €. <br /> . <br /> 1r Privy: Distance from nearest well+.--- ------ ---------_,------- ---I/------ --.Distance from nearest building--------------- ------------------------- <br /> ❑ Distance to nearest lot lire....-.-_-- <br /> - ----------------------------------------------------------------- <br /> Remodeling and/or repairing ---- -- -------•--------••--- ---------------- ---•- ----------- -----"^`�`---- -.. <br /> t <br /> T-- -----z --------- <br /> ---------------------------- --------------- ------ - - <br /> . :---------- <br /> I I hereby certify that I have prepared this application and that the work will be done in:accordance with San Joaquin County <br /> ordinances, St <br /> 'laws, and rules and regulations of the San Joaquin Local Health District. <br /> «� <br /> ------------ <br /> -------------- <br /> or)(S ��---- <br /> `// V d (Owpr and/or " tr <br /> a�ct. <br /> igned)---- fTitl----------=------ --------- -`-_ -=-- --;------- -=----= ------------------------------ e) <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 /> D BY --,---- r= ---------- DATE <br /> APPLICATION ACCEPTED. <br /> -----------------------­------------------------------------=------ DATE---------- - � -------------------------- <br /> REVIEWED BY ---�-�--'---T ---------- ----- - --------- - -- <br /> BUILDINGPERMIT ISSUED._,.--------------------------------------------- = DATE------------------------------------------------------------- <br /> Alterations and/or recommendations----------------- --- --------------- ------- <br /> . _. <br /> -""7w, ----------------- -- ------ <br /> _-_-__.---__-. <br /> ny_ �4 <br /> __ __ _ _ _______ __ ___________ - <br /> F1NAL INSPECTION BY:--- -----------------•--------------- Date <br /> r ,l 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 /> 1 <br /> ES-9-2M 145446 ATWGDD 12-54 <br /> f <br />