Laserfiche WebLink
y <br /> 'I� APPLICATION FOR SANITATION PERMIT Permit No. <br /> ........................ <br /> -•-_.. <br /> (Complete in Duplicate) <br /> C Date Issued <br /> Applica-lion 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 AN OCATI N--...... ------h- ,x Y ------------------------------- <br /> ------------------------- t- --- <br /> Owner's Name...... .. ........ _ '_ Phone__. j ®_ __'T�. _� <br /> ----------------------------------------------------------------_------- <br /> Address----------�1"0 ......... A.....�-• _ <br /> Contractor's Name-------------------------- - -- -- - - ----------------------------------------------------------------------------------- Phone--•-••----------------------------- <br /> Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __1----- Number of bedrooms A.... Number of baths Lot size ------15d----x----I-AP-1-­--------------------- <br /> Water <br /> -___Sd___-x----l-fl-A- ------------------------ <br /> Water Supply: Public system 0010coommunity system ❑ Private ❑ Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand PGravel ❑ Sandy Loam Clay Loam ❑ Clay E] Adobe�ardpan ❑ <br /> Previous Application Made: Yes F1 No [ New Construction: Yes o ❑ <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 wello.l__T' ----- <br /> Distance from foundation--/-•)............Muate-rial_�hc-------- <br /> 9 No. of compartments__-_-.-�.-____-.--_-Size..�.X__ .....Liquid depth...._--F---------------Capacity..... _6__3..... <br /> Dis osal Field: Distance from nearest well01-r�f._Distance from foundation----1_a---------Distance to nearest lot line...__t.... <br /> Number of lines-----_____l__________________---_- Length of each line......./,-_p___�_--____.Width of trench�.X_..a................ <br /> Type of filter materiaf filter material Eg-- Total length 0 -----------------•-- <br /> Seepage Pit: Distance to nearest well______________________Distance from foundation....................Distance to nearest lot line................. <br /> ❑ Number of pits______________________Lining material•-.--_-.._-___--_-----.Size: Diameter------------------------Depth_-_--._-.-.___-___----____----- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material---.----_____.-___________-_-------.-. <br /> E] Size: Diameter-------------------------------------Depth---------------------------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-------.__-_-______-_____.-•--.-------_--. <br /> ❑ Distance to nearest lot line----------------------------- -------------------------------•-------.-.------------------------•---------•---• --- • --------- <br /> Remodelingand/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 /> ordinanceXSfa:e laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)--- 4/{ ,�1 --------------- --------------------------------------(Owner and/or Contractor) <br /> By: --•--•------•-----•---•------------(T'itle)---------------------------------------------------------------- <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 <br /> APPLICATION ACCEPTED BY--- ---- --_-- ------ DATE--• = <br /> REVIEWED BY------------------------ ----- -------------- -- ----------------------------------- ------ DATE. <br /> ............................... <br /> BUILDING PERMIT ISSUED--------------­-------- ---- --•------------•-•. ----------•----• -- •-----------•_.. DATE.---------- a <br /> Alterations and/or recommendations:................ <br /> .................. <br /> -----•------------------------------------------- ...................................................... -----------------------------------------------------------------------------------------------------------------•-- <br /> --------------------------------------------------------------- -•-------•---------------------------------- ---------- <br /> FINAL INSPECTION BY-- -----------------------�--------------------------------- Date-------� .......--�� i--------- ---------- <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 .2M Revised W-2100 <br />