Laserfiche WebLink
APPLICATION FOR SANITATION PERMIT Permit No. ll- <br /> ------------- <br /> (Complete in Duplicate) <br /> Date Issued _!_.1115T <br /> Applica{ion is hereby made to the San Joaquin Local Health District for a permit to construct and install t work herein described. <br /> This application is made in compliance wit ount Ordinance No. 549. <br /> JOB ADDRESS AN OCATION---- ----- -------- <br /> ox----- <br /> Owner's Na e__ <br /> ---------- <br /> -- ----- - ---------- <br /> Address- <br /> Contractor's Name... <br /> - --- ----------------------------------- ------- Phone.- <br /> Installation will serve: Residence W Apartment House ❑ ornmercial E] Trailer Court 'E] Motel E] Other E] <br /> Number of living units: 7/_ __ Nun1ber of bedrooms Number of baths -/-_.-- Lot size - 40 <br /> --------------------------- <br /> Water Supply: Public system EJ " Community 5yStGM E] Privaf Depth to Water Table,�pQ ff. <br /> Character of soil to a depth of 3 feet:" Sand E] Gravel E] Sandy Loam E] Clay Loam E] Clay El Adobe 0 HardpaA <br /> Previous Application Made: Yes E] No New Construction: Yes No F­I <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank-or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest wefi___�r ---Distancq from f <br /> ,punda on. --- --- -------------------------------------- <br /> Size,,; X-4-�_ *-----Liquid depth-. _-- __i_____'_Capacjfy----- <br /> No. of compartments ------- AI---- - <br /> Di l Field: Distance from nearest well_.�------Distance from foundafion__��,_ ......Distance to nearest lot line--..--- �._- <br /> Number o{ lines--------- <br /> or ----Length of each line--..._--_,5 AP...-.---.-.Width of trench.----I-le--------------------- <br /> Type T filfer maf6riaf�w----Depth of filter material.-...__ ---1� -----_Total length_--..-_-..4'-e -----------------4, <br /> 1 <br /> Seepage Pit: Distance to nearest well----lea------Distance frpm __ <br /> fo�ufcSafion---1-,P--------- Distance to nearest lot line <br /> Number of pits..;--j/...... Lining materia� ------Size: Diameter----1-1--------------7 Depth-----a. ----- ------------ <br /> Cessool: Distance from nearewell-----------------Distance <br /> - <br /> psf well_------------ -- _j <br /> Distance from foundaf;on----- -------------Lining'16�1,er'ial--------------- <br /> El Size: Diar�efer____------------------- --------Depth-------------------------------- ------- --------Liquid Capacity------- ---------------------- <br /> --------------.gals. <br /> Privy: Distance from nearest well:.______________------------- ----------------------Distance from nearest building,-------------------------- -----f_1 <br /> Distance to nearest lot line-------------------------------------------------•-------- <br /> -------------------------------------------- <br /> --- <br /> Remodelingand/or repairing —--------------------------------------------------------------------------------------------------------------------------- <br /> ----------------------­------------------------------------------ ---------------------------------------------------------------------------------------------------- -------- <br /> i ---------------------------------- <br /> -----------------------I----------------------------------------- --_-------I--------------------------------------------------------------------------------------------------------------- --------------------------- <br /> Iri <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------*------------------- <br /> I herebycertify that I have-prepared Ai -application and that the work will be done in accordance with San Joaquin County <br /> ordinances, St laws, d r les and, regulations of the San Joaquin Local Health District. <br /> (Signed)---- ---- ----------------------------------------- ---------------------------------------------- (Owner and/or Contractor) <br /> ------ ----- <br /> By::: --------------------------------------------------------------------------------------------(Title - - <br /> ---------------------- ---------- <br /> , size <br /> L e <br /> (Plot plan, showi e of lot, location of system in relation to wells, buildings, etc., can be pl ced reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED By�. ...... ------------------- <br /> ------ ------------------------------------------------------- DATE--.-. <br /> �EVIEWED BY---------------------- ------- -------------------------------------------- <br /> .... ... .i ............................................. -------------------------------- --------------------------------- <br /> BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE.-.--- <br /> 16In-�------------------------ <br /> - <br /> --------------------- <br /> AlWfra,ions ad/or recommendations: --------------- ­----------- <br /> -4 ------------------------- ---------------------------------------- <br /> ---- -------- . ... <br /> ---------- -------i.-\---- ------------------- <br /> -4----------------------------- ------------ <br /> ------------------------------------------------------------------------------------------------------------------------- <br /> ---------------------------------------­1------------------------E------------------- -------------------------------_­--------------­-------- <br /> ------------------------------------ ------------- ---------I------------- <br /> ----------------------------------------------------------------------•--- <br /> -------------*----------- --------------- ----------------------------- <br /> FINAL INSPECTION BY <br /> Date-----------7 <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 614 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> Er-9-2M 145446 ATWOOD 12-5< <br />