Laserfiche WebLink
r <br /> APPLICATION FOR SANITATION PERMIT <br /> Permit No. .-f/es_ ------- ----- <br /> (Complete in Duplicate) Date Issued ------- .------.�Jr <br /> Applica{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 /> -------------------------------•---------------- -•------------ <br /> JOB ADDRESS AND C ION____.. ------- Phone. <br /> ------ _ <br /> Owner's Name - ----- -- - - ------- •-- ------------ ----" <br /> --- ---"--------------- ----------------- ; <br /> Address ----- -- ----------- -----• = ------ -------•--------------------•-•--••----•---... <br /> I <br /> Phone-,--..-------- <br /> Contractor's ame_.------ <br /> Installation will serve: Residence A a # Douse ❑ Commercial ❑ Trailer Court E] Motel ❑ Other ❑ <br /> Number of living units: ___ ____ Number of bedrooms , -. Number of bathsLot size _ a � ----- <br /> ff <br /> Water Supply: Public system&et: <br /> Community system ❑ Private ❑ Depth to Water Tab l ft. <br /> Character of soil to a depth oSand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> I Previous Application Made: Yes ❑ No) New Construction: YeSk No ❑ <br /> TYPE OF I <br /> NSTALLAT16N AND SPECIF C New <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> r i . <br /> s eptic Tan Distance from nearest well.................Distance from foundation____.___._____.---.Materiai--___________-____.___----__________-_-___.._. <br /> No. of compartments --.Size----------- -----------.Liquid depths-------- ---------------Capacity-----------•----------- <br /> sposal Pi . Distance from nearest well-----------------Distance from foundation___________-.__._..Distance to nearest lot line________-_______- <br /> -----Leng6 of each line------------------------------Width of trench ---------------------------------- <br /> ❑ Number of lines---- g <br /> Type of filter material---------------t--------Depth of filter material-----------------------Total length------__---------------------------------- <br /> Seepage`Pit. Distance to nearest well [r -.-Distance f m #o "dation___ --_-_______.Distance to nearest lot line_ <br /> ._.size: iameter_7-__�._...__ Depth-;W?--1=1r -, f <br /> Number of pits___.]---------------Lining material_ -- - �--- -- <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-------------------------.---------------. \� <br /> Distance to nearest lot line------------ <br /> - ----------- <br /> Remodeli ring describe):_ - �" <br /> = ----------------------------------------- <br /> {L ---- - <br /> ----------- ---•----- -------•---•-------------•---•---•---------------------•-------------------••--------•------•------.------••------•--...------•--•--------------•---------....---------------------------------- <br /> } <br /> ------------------------4------- - -------- <br /> -- - - --------••-•---------------•-----------------•-------------------------._--------------•--------------------------••---------------•------------------------------------- - <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; St " ws, an le and re a4ions-of the San Joaquin Local Health District. X <br /> --------------------------------------- Owner an / Contractor) <br /> n r <br /> (signed) ( <br /> -------- <br /> By-----------'---------• ----- -- ------------- ----=---------------------------------------------------(Tit] } �:: <br /> e --- - - <br /> (Plot pian, showing size of I , location f system in relation to wells, buildings, etc., can be p on revers side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY -------­---------------------- ------------------------------------------------------ DATE <br /> --------------------------------------------------- <br /> ----- <br /> REVIEWED BY__. DATE - ---- ------------------------------•-------------- <br /> - - ---------------------------------•----------- <br /> BUILDINGPERMIT ISSUED----------•------------------------------------------------------------------------- DA <br /> qN <br /> Alterations and/or recommendations---------------------- --- -- -----------••----------- <br /> ----- -----•-------------------- ------ <br /> k- --•-------------------•-••--- ----------------------------------------------------------- <br /> - ------------------------------------------- <br /> -- ------ <br /> ----------------- ----- ------------ -•------- <br /> �??_` /L�_�---- ------------- Date-. <br /> FINAL INSPECTION BY:-------- --------------� - -A ------------ - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> " f30 South American Street 300 West Oak S+reef 132 Sycamore Street 814 North "C" Street <br /> Manteca, CaliforniaTracy, California <br /> Stockton, California , Lodi, California <br /> E5-9-2M 145446 ATWOOD 12-54 _ • <br />