Laserfiche WebLink
FOR OFFICE USE: v <br /> --------------------- -------- --- APPLICATION FOR SANITATION PERMIT Permit No. . .. _._.............. <br /> ---------- - (Complete in Duplicate) <br /> Date Issued <br /> - <br /> ----------------------- ------------I---------------- IThis 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 <br /> ��Ordinance No. 549. <br /> JOB ADDRESS A CATION.._!_p�.li+�t.. !4!1._. ¢ / �2d � <br /> Owner's Name.---- - - ----k L <br /> ------ ----- Phone------------------•-----•----------- <br /> Address. •-----. �.Z 5 Contractor's Name------ C,r� - ---------- --- -------- - --,� ----- ---------------------- Phone---------.....---- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer urt ❑ Motel ❑ Other ❑ <br /> Number of living units: __�_._ Number of bedrooms_ Number f baths__:____- Lot size __ --_ _-_-_ _ -------------------. <br /> Water Supply: Public system ❑ Community system ❑ Private Depth to ater Table ------ _ ft <br /> Character of soil to a depth of 3 feet- Sand 0, Gravel--]- Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date------------------- ) No ❑ New Construction: Yes Of /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 T Distance from nearest well. "*./-.--.Dista.n� �e �rom�foundi tion------hq/..._..Material ----�K....---..... <br /> 151, No. of compartments- _'�-.--._ -.::_SizeX9 Liquid de th_--.- Ca acit <br /> Dispos fi .eld: Distance from nearest well...-S0.`*`* <br /> � __.- L® <br /> Distance from foundation-__- _�__._....Distance to nearest lot lin____ ......... <br /> Number of lines--------- _. __Length of each line_-__47,a.�..............Width of trench-.-�.�..._..____._._...___..._ <br /> Type of filter material------c-5 4Z---.-----Depth of filter material------ _�._`_°_..-----Total length__ -Y#�_________________________ <br /> Seepage Pit: Distance to nearest well___..... --------Distance from foundation....................Distance to nearest lot line----------------- <br /> El Number of pits---------------------Lining material------.--------------- Size: Diameter...........__._._..-_--Depth_-.--.------------.--------_____- <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 /> --------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------- <br /> 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, StateZ11aandd rules and regulations of the San Joaquin Local Health District. <br /> (Signed)-------------- -------- 4emin <br /> -----------. . --------------------------------------------------------------(spend/or Contractor) <br /> BY� �' ' (Tale) <br /> ----- --- ------------- --------------- -. ------------------ ------ - ------- <br /> (Plot plan, showing size of lot, location of tion to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ----------------------------------�--------- DATE----�_" _6 . <br /> REVIEWEDBY-------------------------- --------_------------------------------------------------------------------------------------- DATE---------------------------------------------- <br /> BUILDINGPERMIT ISSUED-------- ---------------------------------------------------------------- ---.... ----------------- DATE---------------------------------- <br /> Alterations and/or recommendations-------------- ........ -------- --- ---- ----------- -----------------.......---------.................................... -------- ............... <br /> ---------------------------------------------------_-- ----------------------------------------------------------------------................ ...---------------........----- ----------._...-------•-----------------•-- <br /> ---------------------------------------------------------------------------- -------------------------------------------------- ---------­------­---------- -------------------------------------------- <br /> ----------------------------- <br /> ---------- <br /> ­­ <br /> INSPECTION BY: - �/ - Date_.�j�".d-_ <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 />