Laserfiche WebLink
—/7 <br /> APPLICATION FOR SANITATION PERMIT Permit Not__' <br /> (Complete in Duplicate) <br /> Date Iss&ed -o/ <br /> Ap Cation is hereby maM`6i 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 N 549' <br /> JOB ADDRESS AND LOCATION-------/,<0,__S <br /> Owner's Name-------------------------------------------- ---------- - - -- ------------------------------- -- -- Phone------ ------ ------ <br /> Address---------------------------------- e' <br /> ---------------------- 49 <br /> ------------------------------------------------------------------------------------- <br /> Contractor's Name------------------------------- 17_?_�------------------- ------------------------------------------------ Phone------�_,n f 6 <br /> 7----- <br /> Installation will serve: Residence If Apartment House L] Commercial I-] Trailer Court E] Motel El Other L1 <br /> Number of living units: __/--- Number of bedrooms -A---Number of baths __/--- Lot size ___-_-S _ _!__. -4__ ____________________ <br /> Water <br /> ----- <br /> Wafer Supply: Public system X Community system F-I Private [-] Depth to Water Table.147ff. <br /> Character of soil to a depth of 3 feet: Sand [] Gravel E] Sandy Loam E] Clay Loam E] Clay Ej Adobe X Hardpan F] <br /> Previous Application Made. Yes [] No D( New Construction: Yes E] No E] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> S e,0 f I c"Talk: Distance from nearest well_________________Distance from foundation--------------------Material------ ------------------------------------------ <br /> 0.9 No. of compartments-----z--------------- <br /> _--Size---_---------------------------Liquid depth-------------------------Capacity--------------- ------- NN. <br /> Disposal Field: Distance from nearest well--------------- -Distance from foundation--------- ----.-_Distance to nearest lot line_.______._--_____ <br /> %4— <br /> 16143 Number of lines------------------------------ ----Leingth of each line------------------------------ Width of french <br /> Type of filter material-________________________Depth of filter material____._________,–--------Total length- ------ --------------------------------- <br /> Seepage Pit: Distance to nearest weI114011LE: Distance from founclation-1.5 <br /> ---- Distancb to nearest lot line----/0 <br /> ----------- <br /> Number of pits.--A---------------Lining material-d-e-&.14-----Size: Diameter-6_5------------ DepIk-_,ZJ------------ ----- --- <br /> Cesspool: Distance from nearest weil--------------.--Distance from foundation------------------Lining material_.---___.__._____,__.______.__----___ �1 <br /> ❑ <br /> aterial------------------------------------ <br /> 17 Size: Diameter--- ----------------------- ----------Depth------------------------------ ----------------------Liquid Capacity------------------ ---------gals. <br /> Privy: Distance from nearest well-___ -------_________________________________Distance from nearest building______-_____..._:__----______.___.___._. <br /> z <br /> ❑ <br /> uilding--------------------------------------- <br /> E Distance to nearest lot line-------------------------------------------- <br /> 1 <br /> Remodeling <br /> ine-------------------------------------------Remodeling and/or repairing (describe):------------------------------------------------------------------------------------------------ -------------- ----------------------------------------- <br /> ------------------­--­­-------------------------------------------- --------------------------------------------------------------------------------­­----------------------------------------------------------------- <br /> -------------------------------------------------------------------------------------I------------------------------------------------------------------------------------------ -------------------------------------------- <br /> -------------------_--------------------------------------------------------------------------------------------11------------------------------------------------------------------ ----------------------------- ----- <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, Stat?-Irl s, and rules and regulations of the San Joaquin Local Health District. <br /> % - — <br /> (Signed)--------------- %r�_e�---------- -.-----7_--1 I-- Contract or) <br /> 1112M PM, 7- <br /> ---------- ----------------I---&------------------------------------------------------------ I <br /> By:---------------------------------------- ----------- {Title)---- -- ---------------------- --- <br /> -can be placed on reverse side). <br /> (Plot plan, showing size of lot, location of system Vr=1ation to wells, 6u dings, etc., <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--- -------------------------------------------- ------------------------------------ DATE---------- -- --- <br /> ----- <br /> ------ <br /> REVIEWEDBY---------------------------------------------- ------------------------------------------------------------------------------- DATE---- -----------------•--------- -------------------- <br /> BUILDING <br /> ATE-------------- <br /> BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------ -------------------- <br /> Alterations and/or recommendations:---------------------------------------------- ----------------------- <br /> -------------------------------•--------------------•-----•--------------------------------- <br /> ecommendations------------------------------------------------ ------------------------------------------------------------------------------------------------------------------- ------------------------------------------- <br /> --------------------------------- ---------------------------------------- <br /> ----------I------------------------------------------------------------ - ----------------------------------------- -------------------------------------------------------------------------------------------------- <br /> •---------------------------------------- --------------------------------------- ----------------------------------------------------- ------- ------------------ ---------- ­---------------------------------- <br /> ----------------- ---------- ------------------------------------- -- --- ---- ---------------------------------------- ---------------- - <br /> --------------------------------------------------------------------------- <br /> -s 's <br /> FINAL INSPECTION BY------------- ----------- Date--------------------- <br /> SAN <br /> ate_---------- -------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-9-2M 10-52 Revised W-2100 <br />