Laserfiche WebLink
(ID APPLICATION FOR SANITATION PERMIT Permit No. .... ' . �.... <br /> (Complete in Duplicate) <br /> y <br /> Date Issued ....-f-�3�•�". <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 /> JOBADDRESS AND L QN....i.............-- -- -------------- ..........------�--........- ----------- --------- - -- -----•--............. <br /> Owner's Name �e��'___. ------ <br /> Address------2+ -• ---•----- ................ -------- ............................................................ J' <br /> Contractor's Name---- 1� F - ----------------------------------------------------- Phone,,:+ �. <br /> Installation will serve: Residence U?'i4partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units:/_--- Number of bedrooms w2-. Number of baths Z. Lot size ..sr&'',x.../6.6.• <br /> Water Supply: Publics stem Community system Private Depth to Water Table <br /> --�• <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel❑ Sandy Loam ❑ Clay Loam ( Clay ❑ Adobeardpan ❑ <br /> Previous Application Made: Yes ❑ No 2-'INew Construction: Yes ❑ No g+-' <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> to8n <br /> k: Distance from nearest well------ --__-Distance from foundation....................Material--------:_.. ..._... <br /> No. of compartments--------------- -------Size----------------- ------.......Liquid depth--------------------------Capacity.......... . <br /> eld: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line................. <br /> Number 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 el? ---Distant ►%. o ndation-__!� Dia r;�e to nearest I t line--- ----- �l <br /> Number of pits----7-------_ ---Lining material � ..Size: Diameter-_-S --._-._-.--Depth-_4R%or... <br /> .... <br /> Cesspool: Distance from nearest well------------- ---Distance from foundation...-------:---------Lining material-.--.------------------ <br /> 0 <br /> __---- _-_-:_❑ Size: Diameter------------------------------ -------Depth---------.---.----------------------------_-------Liquid Capacity--------------------.._...gals. <br /> Privy: Distance from nearest well_..:_-.-_-_.. _ .------- <br /> <_......_Distance from nearest building__________________ _____________________ <br /> ❑ Distance to nearest lot line---------•----•-- ------•------------------------------------------------------------------------------------------------------------------ <br /> Remodelingand/or repairing (describe):------------------------------------------------------------------------••-•-------------- -••--•--•-...._......-------_.......................... <br /> -------------------------------------------------------•-----•------------•--••--•-------••-•---------••--.---••••----•------•-•-•-------...................•----••---------•--•-•---•---•-•-----•••-•------•---............. <br /> I hereby certify that 1 have prepared thisa plication and that the work will-be done in accordance with San Joaquin County <br /> ordinances, S e laws, and rule and regulati s of the San Joaquin Local Health District. <br /> (Signed)......... -• •• . ----- •--- Y-- ....... --------- -------------1i. ............................... ner and/or Contractor) <br /> %BY:----------------- --•--•• ------ � w"s�cx (rifle) ..................--------------------- <br /> (Plot plan, showing size of lot, loc ion of system in relation to IIs, buildings, etc., can be placed an reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY.-- ------- DATE "'i <br /> REVIEWEDBY--------------------- ---------- �•---------------- ------.................................... DATE <br /> BUILDING PERMIT ISSUED............:- - .... DATE............ ,Z.................................... <br /> Alterations and/or recommendations:--------------- ------------. .........---•----••--•--•-•-----......-•-•-------••---•--••---------..... '--------•------------------ <br /> ........................... , --- �1 .-..-�.:. __...------ •-- .--- •--•--•-------•----•---........---•-----...---....--•-••......-•---•---••••-• .. <br /> '-�' d.c�.....--�(-s2... ... .............................. ....................................................................... <br /> ----------•---•-----•-•--- ------- ---------------------------------------------- --------•-------•--- -------- •--••---............................................................................................... <br /> ,`;, — <br /> FINAL INSPECTION BY:....... ....�_.---------------------------------------- Date..-- <br /> f <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- 145446 ATWOOD <br />