Laserfiche WebLink
FOR OFFICE USE: <br /> ---------- APPLICATION FOR SANITATION PERMIT Permit No. ..d. ..l .i�'....' <br />------------------- - --7A_0___ <br /> - --- --- - - <br /> (Complete in Duplicate) <br /> ---- ---------- -- <br /> '} Date Issued <br />-------------------------s/- -. ----------------.--- 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---- -�-eZ -1 � <br /> Owner's Name = 0./ -��-- --•----.I............................................................................................................ <br /> --------•----------------------------------- Phone.................................... <br /> Address ------------ <br /> Contractor's Name Y� �_......`�.._l. -------•---•---------•--.... Phone................. <br /> Installation will serve: Residence I 'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other <br /> Number of living units: A.... Number of bedrooms .--.2,. Number of baths .-I.... Lot size .....6.19..X./Zd.................................. <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table _AS�ft. <br /> Character of soil to a depth of 3 feet: Send ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe(Hardpan ❑ <br /> Previous Application Made: (If yes,date--------....--------) No �' New Construction: Yes [!I--No ❑ FHA/VA: Yes ❑ No E3— <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic,V, 4&_1 <br /> Distance from nearest well-----------------Distance from foundation....................Material................................................. <br /> ❑� No. of compartments--------------------------Size................................Liquid depth--•----_----------------Capacity....................... <br /> Disp al`F' Distance from nearest well--_-.---_--.-Distance from foundation-- ...I...........Distance to nearest lot line.-� �......_.. <br /> �,� Number of lines__.._...__.1......................Length of each line......... . ...........Width of trench....%l.y:_.._................... <br /> Type of filter material...-h.�!1..--.-----.Depth of filter material....Lllr ----------Total length.....410.0- •....................... <br /> Seepage Pit: Distance to nearest well-------_-------------Distance fr dation..../p'�_...._...Distance to nearest lot line... -......... <br /> (J� Number of pits.......I.............Lining material...._.../. of -.Size: Diameter------:v............Depth-------------_U............. p i <br /> Cesspool: Distance from nearest well.................Distance rom undation-------------------.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 /> Remodelingand/or repairing (describe):----------------------------------------------------------------------------------------------......................................................... <br /> ----------------•-•------------•-----------•----------•---•-----•------------•-------------------------------•------------------------------•-------------------------------------..........-•---------------------------•--- <br /> •---....-----••--•----...-----•••-----•---•---------•---•••--•••--•---••---•-••----•---•--------------•-----•-----•-•••-----•----•-----•-•••-•-•--•-•••------------------•--•----............................................ <br /> I hereby certify that I have prepared this I <br /> a d that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules end regulatioJoaquin Local Health District. <br /> (Signed)------. --------------------------------------------------- --------- ---••---•---••--•---------------•••---------•-•.........--•-----(Owner and/or Contractor) <br /> By:---••--•-----•-----•--------•------••--------•----- -- ------ ------- --•--•--•--•---••-------•----------•••••(Title)--------------------------------------------...-- ----------.... <br /> (Plot plan, showing size of lot, location of sys to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------ -------':e"I ......................... DATE_....... .-'---------------------- <br /> REVIEWEDBY............................ ••---------------------------------------------------------------------------------------------- DATE............................................................ <br /> BUILDINGPERMIT ISSUED....................................................---------------------------.................... DATE..........................................................._ <br /> Alterations and/or recommendations:--------------------------------------•------------------------------•-----------------------....----------------------------•-•-•--•----•-•----•--.....------ <br /> -•-•------------------------------------------------•------------------------------------......------------------------------•-----------•--------•-------.....--••--••-------------------------------------------------...--- <br /> •--•-•--•-----•------------------•-------•-•------•--•---•----•-------•. --------•---------------...---------------•-•--• -•-•------•••-•-----•-••-•••--•.....--•----•--•--••---•-•-•- •--...........-•----........ <br /> -----------------------------------------------------------•--------------------------------------------------•---------•----------......--------•-------------------------•----•--------•----------------------•---•-----•-- <br /> ------------------------------ -------------•-•------ --- -•------------------------------.....----------•---------------••-------•---•--•----.....-----------•--•--------•....-------•-----••----•---------•- <br /> FINAL INSPECTION BY:. --------------------------- Date <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Strut 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 6-59 RM 5-61 ATLAS <br />