Laserfiche WebLink
FOR OFFICE USE: <br /> _____________________ ______ _ APPLICATION FOR SANITATION PERMIT Permit No. , '.flP. <br /> ------------ <br /> -- ----- ------------------------ (Complete-in Duplicate) <br /> Date Issued <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 No. 549. <br /> JOB ADDRESS AND LOCATION-/ <br /> o <br /> ----W—--------------------------------------------- <br /> Owner's Name---�-p.(.� --- - --�'�----- ----��.aJ --- ---------------- Phone------------------------------------ <br /> Address--•---------..�i- .--•-•-•." .1. - cam <br /> Contractor's Name - = Y --------------------- Phone------------•-----------------•--- <br /> Installation will serve: Residence (Apartment House ❑ Commercial ❑ Trailer .Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _/____ Number of bedrooms._ Num;?Depth <br /> f baths __/_._ Lot size __�_ <br /> Water Supply: Public system ❑ Community system ❑ Private t Water Table __.__ _ ftCharacter of soil to a depth of 3 feet• Sand ❑ Gravel ❑ Sandy Loam lay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ �'`� <br /> Previous Application Made: (If yes,date------------------- ) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ <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 /> f <br /> Dispos field: Distance from nearest well---��.-....Distance from foundation---Jf?-_.------- <br /> Distance to nearest lot line-__'S.-___----- <br /> Number of lines__._________...____.____--- _ Length of each line_____-__---__.--------------Width of trench_-___.____.______________________ e <br /> S nf< <br /> Type of filter matenal____..__.__./.4,--------Depth of filter material____/�_-_........Total length----$_S_______________________...__ <br /> P! Distance to nearest well-----4PO?......Distance from foundation__1°'e-1...........Distance to nearest lot line-s_.'0___.__ <br /> 1qJ Number of pits. . ....`----._-_--Lining material____ Size: DiameteDepth---10_*--------------------- <br /> Cesspool: Distance from nearest well ---------_------Distance from foundation------..__.------ -.Lining material_.-----__..__-._-.-.____..____-.___-_ <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 /> - ----s------'E-_ ---- -•'„--------------•---••----------------- --------•- <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, &anlesand regulations of the San Joaquin Local Health District. <br /> - -(Signed)--------------- - - ---- -- - rand/or Contractor) <br /> By:------------------- - -- '------ --- -- ----------- ------------------------(Title)---------- -------------- ------------ --...----- ------ <br /> (Plo+ plan, showing size of lot, location of system in relation tow IIs, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--------- ------------------------------------------------------ DATE---� '--__— --_ .�.l_--- <br /> REVIEWEDBY----------------------------------•--------..._ ----- ---------------------------------------------------------- DATE------ -------------------- <br /> BUILDINGPERMIT ISSUED-------- - ---------------------------------------------------------------------- ------------------ DATE----------------- ------------------------------------------- <br /> Alterations and/or recommendations:.------- ------- --------------------------- --------------•--------------------------------------- <br /> -------------------------- -------- ---- ----------------------------------------------------------------------•------------------------- --- ------ <br /> -------------------------------------•----------------...------ ----------------------------------------------_. ---------------------- ------------------------------ ---------------- ------ ................. <br /> ----------------------- ---- --------------------------- --- ---------------------------------------------------- ------------ -------------------------------.-------- --------- ---------------------- <br /> FINAL <br /> --- ------FINAL INSPECTION BY:---- ------------------ Date--- . '-y =4-7- {` <br /> SAN JOAQUIN 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 /> E.H.9 2M 1.67 vanguard Press <br />