Laserfiche WebLink
APPLICATION FOR SANITATION PERMIT Permit No. .. _�. �.. <br /> (Complete in Duplicate) ( � K <br /> dl*NDate Issued _._./1..._� . <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 y O dinance o. 549. <br /> JOB ADDRESS L AT N ... --- "- ------ . -- ~ <br /> O.L. <br /> Owner's Name. . -------------------------------------------- . Phone // <br /> ------­----------------------- ----------------- <br /> _ <br /> '- -- -- -- ------------- <br /> ---------------- <br /> _,__-L <br /> Name•.-- -•--•-• ------•-- -- ------------------------------------------------------------------------------------------------------------ Phone................................... <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motol ❑ Other ❑ <br /> Number of living units: ..1---- umber of bedrooms ._ _ __ <br /> Number of baths __ . Lot size ___ _. ----------------- <br /> Water S4Pply: Public system Community system ❑ Private 06"'Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: an <br /> Sd Gravel [-] Sandy Loam Clay Loam E] Clay ❑ Adobe Hardpan E]Previous Application Made: Yes E] �o New Construction: Yes Loam <br /> ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if PHO;sewer is available within 200 feef.) " <br /> Septic ank: Distance from nearest well.. __Q-!_"D1stan a fr f Oaf ion.��._....__._..Mat Pial______---------------_______ ................ <br /> No. of comp7artmelts4--•-•- -- ----------- 'ze� Liquid l?th Capacity.. __Qt <br /> c1----- <br /> Dispos Field: Distance from nearest II+� ___.___._ istance from foundation___-_.T '"Distance to nearest lot li � ?! / <br /> tt-- <br /> Number of lines.__..__._ ,, ___________ Length of each line-------------- <br /> - Width of trench <br /> __ �,! <br /> Type of filter mater _ h epth oT filter material-._.--I--. ._-------Total length-------_fes <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 neprest •______________•Distance from foundation__-_L-----------Lining material____-______________.________--_.__--. <br /> ❑ Size: Diameter------------- ------- ---------Depth----------•---•--------•----------------------------Liquid Capacity------ •---------.------gals. „ A <br /> Privy: Dista'jj'te from nearest wall__-________________________•-____•-__-__-___-_-_Distance from nearest building_________-___-___________-_-______--____-. �J' <br /> ❑ Dist�dnce to nearest lotline---------------------------------------------- -----------------•---------------------------------------------- . <br /> Re od�'fJ a r re Flairing (describe):--------`----------------------------------------------------------------------------------- ----------------------- <br /> ------------------------ <br /> ----------------------- ----- ------ -------------------------------------=----------------------------------------------------------------------------------------------------------------------------------------------- <br /> I <br /> ------------------------------------- ----------------------------------------------------------------------------------------------------------------- -----------------•--•••---------------------•----•---------------- <br /> I hereby certify at I have prepared this application and that the work will be done in accordance with San Joaquin County - <br /> ordinances, State law , and rules and regulaflons of the San Joaquin Local Health District. <br /> (Signed)---- • • . . ...................................................... -------------- --- ------------------------------------(Owner and/or Contractor) <br /> ffjj�� r ` P <br /> By� f,E� •- �Qr t � --------------------------------------------------------- <br /> (Plot Ian, showing size-of lot, location of system`"tn relation to wells, buildings, <br /> P etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED 'It, <br /> -------- -------� ------------------------------------------------------------------ DATE--- <br /> --- ------ <br /> REVIEWEDBY------------------- -------- ------------------- -=-------------------------------------------•-••--•----•----•-...----- DATE i�----------------------------------------------- <br /> BUILDING PERMIT ISSUED DATE ..''� <br /> .._________-__.--__________.__......__..__._ <br /> Alterations and/or recommendations_______________ <br /> ........... ..---- -----------------------------------I--------------- <br /> --- ------- -- ------------------------------------------•------.......-........................ . <br /> r ----- <br /> -----------­--------- ` -----"'---------------------------------------- -- -------------------------------------------- <br /> FINAL INSPECTION BY:-- -- ;��_. ---------------------- Date------ --' - -- .......... <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 10-52 Revised W-2100 <br />