Laserfiche WebLink
FOR OFFICE USE: <br /> -----------D <br /> - - - <br /> --------- -- --------- --- <br /> __________________________ APPLICATION FOR SANITATION PERMIT Permit No. .l ..11.1..... <br />-------------- ----------------------------------- (Complete in Duplicate) Date Issued/ <br /> D <br /> ----------------------- This Permit Expires 1 Year From 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 Yo. 549. <br /> JOB ADDRESS AND LOCATION------��------ -- - -- --------------------- --- <br /> Owner's Name------------ ...... . • r Phone ------•------------------- <br /> Address-------------- ....... . --- ---- .------------. .--- --- -- -- --- -- -•------- <br /> Contractor's Name-------- --------------- --- ------ Phone----------------------------------- <br /> Installation will serve: Residence R3- Apartment House ❑ 'Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _.f___ Number of bedrooms _e--. Number of baths . .- Lot size _ G? ..���- _.__--.__---------------- <br /> Water Supply: Public system ❑ Community system 3**1rivate ❑ Depth to Water Tables? ft. <br /> Character of soil to a depth of 3 feet: Sand [] Gravel ❑ Sandy Loam Eq`'Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date.--------I'--------.) No ET'New Construction: Yes ❑ No [a" FHA/VA: Yes ❑ No El— <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.................Distance from foundation--------------------Material-..___._-.-....-._-------...._.__-.-------...._-. <br /> No. of compartments-------------- --- -----Size--------------------------------Liquid depth----------- ----------Capacity----------------------- <br /> Disposal Field: Distance from nearest well_----- -----Distance from foundation--- /--__.Distance to nearest lot line___-----... <br /> �^ Number of lines-------- .___-,:.-_. ._--Length of each line__, �._.le_...�._....Width of trench.,2._1........................... <br /> Type of ilter material-1�. � ._Depth of filter material...Vic .._'-----_Total length--3Z-2............................... <br /> Seepage Pit: Distance 4c, nearest well-----:_ -----------Distance oPete.from foundation---/ --------Distance to nearest lot liie..`7-------- <br /> �— Number of pits-----4_..--..__-Lining mate ria l--ol ..Size: Diameter_. ---------Depth- <br /> Z4 <br /> Cesspool: Distance from nearest well-----------------Distance from foundation_-----------------Lining material------._.__-_l--_...--_-----._.--.--- <br /> ❑ Size: Diameter----- --------------------- ----------Depth------------------------------- --------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well-_ ---------._.__-----------------------------Distance from nearest building-.____________________________.-._--_. <br /> ❑ Distance to nearest lot line------ - - ------------------------------------------.._..------------------------------•------ --------------------------------- <br /> Remodeling and/or repairing (describe)--------------- ------------ -- ---------------- <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 a d regulations of the San Joaquin Local Health District. <br /> c <br /> '' -- ---------------------------------- r Contractor <br /> (Signed)----------------------- <br /> ---- -- <br /> -------------------------- --- .........6---���'----------(Title)----- ------------ - <br /> (Plot plan, showing size of lot, location of system in relat' t0 wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-------1 ! --------- ` .".'L-- --- DATE----- / -`/ <br /> c'► 2 -- ---------------�-`----+--------- <br /> REVIEWEDBY-------------------- ----- ------------ ---------------------------------------------------------------- DATE------------------------------------------------------------ <br /> BUILDINGPERMIT ISSUED--------------------------------------- ------------------------------- ---------------------- DATE------------------------------------------------------------ <br /> Alterations and/or recommendations:.....__---.('. ...-- _ ._�_.. .-� _�-._._.__�': �''7--- `e '-: `--==`�^----=' - �_.---- <br /> `u. �� -----•---------------------------------------------------------- <br /> ---•-----•----------� -------•- ------- ----------------------------------•---- <br /> ---------------------------------------------------------•----------------------------------------•------------------•------- ---------------------------------•-•-- --------------------------------------- <br /> ----------------•------------ ------------------------ ---------------------- --------------------- -----•----------------.-----------.-------- ------------------------------------------------------------. <br /> FINAL INSPECTION BY:....._l�[ '-----------r <br /> Date--.---�-.-�--� � � <br /> SAQUIN LOCAL HEALTH DISTRICT <br /> ' 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br />