Laserfiche WebLink
41 � _ _ <br /> 4` '`APPLICATION FOR SANITATION PERMIT Permit No. -___.7...�1.....�..... <br /> (Complete in Duplicate) `e <br /> Date Issued _`_ `_-- <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 /> JOBADDRESS AND LOCATION/------- --------------------- --�-----�---�-------------- ------------- ------.._...-----------------------------------•-------•--- ---------- <br /> Owner's Name___. ------ - Phone <br /> Address----- - - ---------------• -•----------------------------------------------------------------•-------_-_---------- <br /> _ <br /> Contractor's Name_je_t -i-`--" <br /> Installation will serve: Residence I- Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> + Number of living units: __1_ Number of bedrooms Number of baths ---j__ Lot size ____ --------------- <br /> Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table /,,vo ft. <br /> Character of soil to a depth of 3 feet:, Sand E] Gravel El Sandy Loam El Clay Loam [:] Clay [:] AciobeQ_ Hardpan ❑ <br /> Previous Application Made: Yes E] NoCWL_ New Construction: Yes q_ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer-is available within 200 feet.) <br /> Septic Ta k: Distance from nearest well__:_____________Distance from foundation--------------------Material------------------------------------------------ <br /> o. of compartments--------------------------Size--------------------------------Liquid depth-----------.---------------Capacity----------------------- <br /> Disposal Field: .. is ante from nearest well-----------------Distance from foundation....................Distance to nearest lot line----------------- <br /> umber umber of lines-----------------------------------Length of each line-------------................Width of trench----------------------------------- <br /> Type of filter material_________________ _______Depth of filter material-----------------------Total length..-.....--------___________._________-___. (� <br /> Seepage Pit: Distance to nearest well---- ,d7 istance from foundaticn___ ._ <br /> _ ._.Dsstan a f? nearest lot line----�-f3____- <br /> p� Number of pits------ -------------Lining material_ Diameter__.._c _.-.Depth.--__.. _ —__________ �- <br /> Ces pool: Distance from nearest well-----------------Distance from foundation---------------------Lining material--.--------- _-_____-._. <br /> ❑ Size: Diameter--------------------------------------Depth----------------:---------------- ------------------Liquid Capacity-----------------------------gals. �l <br /> Privy: Distance from nearest well---------------_---_-----_-----------------------Distance from nearest building_____________.________________.____-____. <br /> ❑ Distance to nearest lot line-------------------------- -----------------------=------------------• ---••--- ------------------------------------------------------------ ��t <br /> Remodelingand/or repairing (describe)------------------------------------------- ------------ •------------•-----•••------------------------------------:------------------------------------- <br /> ------------•----------------------------------------------------------------•----- -----------------------•-------••---------------_----------•--------•--------------- ------------­---­--------- <br /> -----•---•-------------•----------------------------------------------------------- -------------------------------•-------••------•-----------------------------------•---------------------- <br /> --------------•------------------------------------------------ <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, State laws, and rules eregula+ions of the San Joaquin Local Health District. <br /> f , <br /> (Signed) ----- M - - ---------------------------------------- - -----(Owner and/or Contractor) <br /> By..... ---- -- ------(Title)----- ------------- ---- --------------- <br /> (Piot 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 /> APPLICATION ACCEPTED BY--- ------ -------- ------ <br /> ----- ---------- ------------------------------------------------ <br /> DATE---------_5�__...----------------------------------------- <br /> REVIEWEDBY-------------------------------------------------= ------------------------------ ------------------------------------- DATE--------------------------------------••---• ............. <br /> BUILDING PERMIT ISSUED-------------------- ---- ---- ------------------------- ------ DATE------ - <br /> Alterations and/or recommendation : --- <br /> - ------------------•----- -------------- ---- <br /> ai ............................................... <br /> -------------------------------------------- - ---------------- .....3.............. -------------------------------------------------------------------------------------------------- ----------------------- -- --- <br /> FINAL INSPECTION BY:.. ---------------- Date -- - ---J�� <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---9 745446 ATWOOD <br />