Laserfiche WebLink
Q ^� APPLICATION FOR SANITATION PERMIT Permit No. ._L- /- --�..... <br /> �I <br /> (Complete in Duplicate) <br /> Date issued <br /> Application 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 /> JOS ADDRESS AND LOCATION jb `5 ----J_A .... '----------------- -------------------------------------------------------------------------------=------- <br /> Owner's Name == 3------ :----•-------------------------------------------------- - -------------------------------------------- Phone-------------------------------- <br /> Address----------- <br /> ------------------------------- <br /> Address----------- -- - ---------- ----------------- -- ------------- --- <br /> Contractor's Name-- Y� -------- -------------- Phone_ ----- <br /> 7 <br /> Installation will serve: Residence A rtment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -j___ Number of bedrooms _- _ Number of baths ----L Lot size -..------------------------------ <br /> Water Supply: Public system ❑ Community system "°''Private ❑ Depth to Water Table <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe FAo'<ardpan ❑ <br /> Previous Application Made: Yes ❑ No New Construction: Yes to ❑ FHA/VA: Yes ❑ 'No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> �,(No.,septia-tank or'cesspool permitted if public sewer-is available within 200 feet. <br /> ` Material -6_ - <br /> Septic T k: Distance from nearest well--. O*-e.Dista. e from f u dation -__ _____ ____. <br /> No. of compartments-_--__-- - -- --- -� --•---Liquid depth----- --._.- --------Capacity_- - <br /> ---------Size - <br /> Disposal Field: Distance from nearest well-_WPAAOI_Distance from foundation--A_-_ ---___Distance to nearest lot line-4-L!------ <br /> Ll <br /> ____._ <br /> L] Number of lines--------------A----.------------Length of each line------------7X!----=---Width of trench------ ------------------- <br /> Yp Depth of filter material_._.' I _Total length--____f _r___________ ___ <br /> «,.: <br /> ;V T e'er filter material ,4 <br /> S Distance to newest well ____Distance fro. foundation- ________:Distance to nearest lot line ------------- <br /> _ <br /> ' Depth <br /> Number of pits_`,-_- -----__Lining materi il_______ -- t--Size: Diameters;_.i p r <br /> � "i <br /> Cesspool: Distance from nearest well!----------------Distance from foundation--------------------Lining material---.--------------------------------- <br /> El Size: Diameter-,L----= =------�--------------- <br /> Depth------------------. ------------------------------ Liquid Capacity gals.' <br /> Privy: Distance from nearest we11___---______________________________________ __Distance from nearest building-------------------------------- -___--.-. <br /> - <br /> ❑ Distance to nearbst lot line-----------------„=---- --------------------=----------------------------•-------------------------------------------- <br /> Remodeling and/or repairing,(describe):---------- --------------------------------------------------------------- ------------------------------------------------------------------------------- <br /> T <br /> ---------------- ---------------------------------------•----------•----------------------------------------------------------------------------------------- <br /> ------------------------ ------------•------ --- <br /> * – ------------ = == = "==_== - _,��;______ --__Mr__ - - =-----------=----------------------------------------------------------- <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 and rules and regulations of +he San Joaquin Local Health District. <br /> 4 r <br /> ` � � <br /> --(Owner and/or Contractor) <br /> (Signed <br /> r Toler± _ -------------------------- <br /> sY� -=- ----------==- -------------------------------------{ )-----= - <br /> (Plot 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 q� <br /> APPLICATION ACCEPTED BY-------- ------ ------ i'C` ------------------------------------------------------------ DATE------ ���! ._3C? <br /> REVIEWEDBY------------ --------------------------------------------------------------- ------------------------------------------------ DATE----------------------------------------------------------- <br /> BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------ <br /> Alterationsand/or recommendations----------------------------------- --- ------------------------------------------------------------------------------___----___--•---------------------------- <br /> ------------------ ---------------•----------------------- ----------• ------------------- -------------- ---------------------------- <br /> ----------------------------------------­------------------------------------------------------------------------------------------------------------- -----•----------- <br /> FINAL INSPECTION BY:--------- = Date ---- --r-r�---dS ---- ----------------------------- <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 3� Tracy, California <br /> ES-9-2M , Revisea 1.57 F.P.00. 7 <br />