Laserfiche WebLink
APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) a J <br /> Date Issued <br /> Applical-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. � ?� 77-------� /rWe? 0i7 -• ------------------ <br /> Owner's Name------------;_SC�c -- '------ -••--- --- -•- _.:W :.: Phone. a. �� <br /> Address --------------- ------ ---------------- --------------------------------•-•----------------••-------••-------------......._..--=------. ---- ----------------------•- <br /> Contrac#or's Name -- ----•- -- -----•-------------------------------------------------------------------•-------- Phone----------------------------------- <br /> Installation will serve: .Residence ®,"A'partment House ❑ Commercial ;❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __f__ Number of bedrooms __Number of baths ___...-_ Lot size --- _----------------- <br /> Water <br /> ________._ ._Water Supply: Public{system [P­ C;,ommunity system ❑ Private .❑ Depth to Wafer Table 34 f+. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel L] Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> Previous Application Made: Yes-0 No New Construction:-Yes ❑ 'No ❑_S-ti-7_� "� �'—' <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tan0or cesspool permitted if public sewer is available within 200 feet.) <br /> S is Tani Distance from nearest well-----------------Distance from-foundation--------.----------.Materiai______`____________________________-----___-__. <br /> No: of.compartments--------------------------Size-----------------------------------Liquid depth--------------------- I-'.Capacity-----------•----------- <br /> I sal Ids' Distance from nearest welf------------------Distance from foundation--------------------Distance to nearest lot line......'_-_______ <br /> Number.of:lines-----------------------------------Length of each line------------------------------Width of trench----------------------------------- <br /> Type of filter material-____s__�_ _---�___/_1__-Depth of filter material____-r -__._Total length______________________________ _�_-- <br /> Seepage it: Distance to nearest well-W, !"`'-__----Distancejyf�, fo ndation__ ______________,�Di fle to nearest lotlinnee-7 !_________ <br /> !%[% j p <br /> Numi�er of pits----�---------------Lining. material--------------'---- ..Size: Diameter---'------'---------- -Depth------'---------------=----____-- <br /> % <br /> farce from --e t well-----------------Distance from foundation.__________._____.Lining material___._.�_____________________________- <br /> Cesspool: Distance from nearest <br /> Liquid—Capacity--- gats._=� J, <br /> • ` , <br /> Privy: Distance from nearest well---'--------------------- -----------------------Distance from nearest building------------- --- ----------'------'-'-- V <br /> ❑ Distance to nearest lot line----------------------------------------------=--------------------------------:----------------------------------------------------------------- <br /> Remodeling and/or repairing (describe)------------------------------------'--------------•-•-_---........I......:.------------------- : --------------------------•-•...----------------- <br /> ---------------•------------••----------------------•--k---•---------------•-------------------•--------------•----•------•---------------_------------=------------------------------ ------ <br /> ---- ------- ---------------------------------------------------- <br /> J <br /> I hereby certify that I ave prepared this application and +hat the work will �e done in accordance with San Joaquin County <br /> ordinances, State la , , and rule re ations-of the San Joaquin Local Health Districf. , <br /> (Signed) -- --- --- --------------------------------- - ------ - ----- --- ------------------ --- -7 ontractor) <br /> Sy:.................................... - (T�#le) -- ----------------------------- <br /> (Plot plan, showing sire-'of,lot, location of system in relation f wells, buildings,iec., can be placed on reverse side). <br /> ;j :.. <br /> " FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---- ---------------------- ' -- --'- -------------------•----------------------------------. DATE.. ---- -`'�',j,5---------------- ---------- <br /> REVIEWED BY - -------------- •--i -------- DATE--- ---------------------------------•--------------------- <br /> BUILDINGPERMIT ISSUED-------------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- <br /> Alterations and/or recommendations:------------------------------------------------------------.----------------------------------------------------------••-----------t--- <br /> -----------------------------------------------------------------------=------------------------------------------------------------------------- ------------------------------------------------------------ --------------- <br /> FINAL INSPECTION - ����J Date - =' r - <br /> --- --- -----------------•------- ............. <br /> 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 /> ES--4--2M : Revised W-2100 <br />