Laserfiche WebLink
APPLICATION FOR SANITATION PERMIT / 0 i <br /> `.r <br /> (Complete in Duplicate) <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct an in, <br /> the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCAT ON----------- -I�---k--- --------F-1---�- '---------- <br /> -- --------------------------------- <br /> Owner's Name-------------------- --- ------- --��-VI------------- ------------- -- ------- <br /> ------------------------------- Phone------------------------------------ <br /> Address------------------------------ -: :-=------------------------------ ------------------------------------------------------------------------------------------------------------------------------- <br /> . ��✓0 `��--- - Phone----------------------------------- <br /> Installation <br /> Name-------------------------/Apartment <br /> --------------- --------------- ------------------ <br /> Installation will serve: Residence House ❑ Commercial EJ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: Number of bedrooms.?;. Number of baths & Lot size_____________ ____1 ____________________ <br /> Water Supply: Public system Community system [:1 . Private ❑ <br /> Character of soil to a depth of 3 feet: Sand ElGravel F-1SandyLoam El Clay Loam E] Ciay E] Adobe Hardpan ❑ <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 well__c__� ____Distance from fgundation______�___________.Material________CQkc_-1------i----- --- <br /> ------------Ca acit Zpp-----------Size---�X -_4�___-----Liquid depth-------- 4 ------- <br /> No. of compartments----------�+ p y-- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- <br /> ElSize: Diameter--------------------------------------Depth--------------------- ---------------------------- <br /> Privy: Distance from nearest well------------------------_------------------------Distance from nearest building--------------------- <br /> ---------------- <br /> _M <br /> ❑ Distance to nearest lot line________________________________________________ <br /> Seepage Pit: Distance to nearest well---------------------- from foundation--------------------Distance to nearest lot line----------------- <br /> 171 <br /> _____________ -_v <br /> ❑ t <br /> p' In ---------------- <br /> __ ng material-----------------------Size: Diameter -------Depth--------------------------------- <br /> s ..I <br /> Disposal Field: Distance from nearest w II___ <br /> ----.Distance from foundation____�_�_:_a_____--Distance to nearest lotiline----- ______._ <br /> Number of lines______________ Length of each line------r{_(��___, £t Width of trench____2..__________________--__._ <br /> Type of filter material____ _______________Depth of filter material________ .______ <br /> Remodelingand/or repairing (describe)-------------------------------------------------------------------------------•---------------------------------------------------------------------•---- , <br /> ----------------------------------------------------------- ----- - -------- <br /> ------------------------- ------------------------------------------------------------ ------•-•---------------------------------- <br /> 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, an rules and r `gulations of +he San Joaquin Local Health District.. <br /> (Signed) ______________________(Owner and/or Contractor) <br /> ----- - ------ --- ------ --------------------------- Tile <br /> (Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be filed with this application). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------------ - ------------------------- <br /> - <br /> ------------- DATE--------------- -------- -� ------------------- <br /> REVIEWED BY------------------------- - ---------------- ----------------------------------------- - DATE--------------------- ------ ---------------------------- <br /> -------------------------- --- --- -- <br /> BUILDINGPERMIT ISSUED---------------------------- ------------------------------------------------------------------- DATE------------------------------------------------------------ <br /> Alterations and/or recommendations------------------------------------------------------------------------------------------------ -----------i ------------------ ,-------------------- <br /> ---------------------------------------------------------------115-----V`=M-------favf�=_) _AteA ------ <br /> U <br /> --------------- <br /> ----------------------1�•--- Af--------ivy ------- � -------------- <br /> --------------•---------------------------------------------------------------------------------- W.4 --------------- <br /> - ---------------- <br /> --- - ----------------------------------------------------------------------------- -----------------------------------------------------------------------* <br /> PERMIT No._ i_Q________-- ISSUED___________ ____'�--_-�- --- ----- (Date) FINAL INSPECTION BY:_____________---------__-: <br /> s_ f f 6 -- <br /> -------------- <br /> Date--------------------------------------------/---------------------- -•--------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> \V; 130 South American Street <br /> Stockton, California <br /> ES-9--2M 4-50 W-1b39 <br />