Laserfiche WebLink
Metadata
Document management portal powered by Laserfiche WebLink 9 © 1998-2015 Laserfiche. All rights reserved.
APPLICATION FOR SANITATION PERMIT Permit W. 4�_Ipa ..... <br /> (Complete in Duplicate) <br /> Date Issued -2-A65. z' <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--- •----5/_ ........5P------- -- --------------------------------- -------• --- -- -----------. --- <br /> Owner's Name-------------------------------f4ad?A-----_�•'y �F'X' �� ?r-- ---- _ Phone <br /> Address..... d A '��^��5 ----------------------------------------------------- .............. <br /> Contractor's Name------------------------------------------------------------------------------------- ------ ------- ------------------------------ Phone................................... <br /> Installation will serve: Residence M Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ---- Number of bedrooms _. __ Number of baths __/__... Lot size -------j�Q ........ ------- <br /> Water Supply: Public system 4 Community system ❑ Private❑ Depth to Water Table -------- ft. - <br /> Character of soil to a depth of 3 feet: _Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay❑ Adobe 2] Hardpan ❑ <br /> Previous Application Made: Yes ❑ No ❑ New ConstructioTt: 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-3-0-0------Distance from foundation-----/(0. __•__Materia------ ..... <br /> No. of compartments________- ------------Size___��_S ------Liquid depth-------- _.�_-__-____Ca aci <br /> Disposal Field: Distance from nearest well__j0_?7_"._Distance from foundation. _ Distance to nearest lot line.....9 <br /> Number of lines_____________' ..__ Length of each line______-_��,. jJ----.Width of trench-_____,��+.....I <br /> Type of filter material /� --Depth of filter material_._f�i Total length.. 1',�' . <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: <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 <br /> -------------------- ---------Remodeling and/or repairing (describe)------ -------- - ------ -•-••-------------------------------------------------•---------------------- ------ --•- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> ---------------------- ---------------- ----- -------------------------------- -------------•--•---------------•----------------------- ---------•---------- -- -------------- -- --------- <br /> I hereb certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, la and les and regulations o the San Joaquin Local Health District. <br /> (Signed) Z� _______Owner and/or Contractor <br /> By:-------------------------------------------- ----- ----- -- ----------------------------•.-_---------------(riifle)--- _------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> R Q TM T USE O LY <br /> APPLICATION ACCEPTED BY---- -f -------- ATE------ �� . <br /> REVIEWED BY ------------------------------- ------------ DATE ------.. -- <br /> BUILDING PERMIT ISSUED.............----------------------------------------------------------_--- -------------------- DATE------------------------------------------------ <br /> Alterations and/or recommendations------------------------------------- -------...... ----------------------------- ---------------------------------------------------------------- <br /> -••-•••-----••-----••-•----------•----------------------- -------------------------•-----------------------------------------------------•-------------------------------------------------------------------------------- <br /> FINAL INSPECTION BY----- ---------'/--------------------------------------------- Date•.--_-.-_-------- W <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 8-51 Revised W-2100 <br />