Laserfiche WebLink
F , <br /> APPLICATION FOR SANITATION PERMIT Permit No --_----- <br /> ' (Complete in Duplicate) <br /> 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 L9CATION......_.._ <br /> --------- ----- - - - ---- <br /> Owner's Name_.....-- - Phone---- <br /> Address. . c !�� ----- -- ----- --------= ..'194 _A ------------------ <br /> Contractor's Name...... ..�........ - ------ ------------------------------------------------------------------ --- Phoneme_---------­--------­-------- <br /> Installation will serve: Residence R Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number-of living units: __-___Num_ber of,bedrooms A,_. Number of baths .,�__ Lot size ....../9— ------ <br /> - <br /> Water Supply: Public system ❑ Community system ❑ Private PO Depth to Water Table.,49 ft 3 <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam J$( Clay Loam 0 Clay ❑ Adobe❑ Hardpan <br /> w _ Previous Application Made: Yes No New Construction: Yes X 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---, .._---Distanceefrom,foundation--���--;-•----.Materia!-. !--" `.. ------_- <br /> No. of compartments--- A--------------Size---. _X __?S--Q-----Liquid depth___. ` ,'.,-:.�.-___:Capacity <br /> Disposal Field: Distance from nearest well----w*V' .__.Distance from foundation-•_- ----_'Distance to nearest lot'line__.__X!, .... <br /> ( Number of lines_______________ ,__ Length of each - <br /> ._ Width of trench'- ..JL -- <br /> Type o€ filter material_a� % ��Depth of filter material--------��y --Total length...... ................... --- <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 /> _ ❑ - -mss: DiatetaF -� -__ _ _ ►?«�r+ +}; _-.y=x. Liquidanacity_ _Lc als. <br /> V+ <br /> Privy: Distance from nearest well___________ __________ ______ •____---_-Distance from nearest building._..,.- ......_-. ........-__I.._... <br /> ❑ Distance to nearest lot line--------------------------------------------------------- -------- ------- - ----- ------------------------------------------ <br /> Remodeling <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, State aws, and rules and regulati ns of the San Joaquin Local Health District <br /> (Signed) -- ---- '---------------- -- -------- -----_- ---- - --- -- ------(Owner aodylo Cmi.et%r) <br /> BY� - ------------------------------------ -V {{ <br /> --------------------------------------------------(Title) --------------- <br /> (Plot plan, showing she of lot,location of systein in relation to wells, buildings,efc., can be placed on reverse side). <br /> 1Z At FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--- --- ----- • - -------------------------------------------------- DATE--/.q. �$• "I`' <br /> r. REVIEWED BY-------------------------------------- ---------- ----- --- -----. DATE......................... <br /> BUILDING PERMIT ISSUED.......................................................... --------------------••.............. DATE._ ...... -- ---------------- - ------------------ <br /> Alterations and/or recommendations: --------------------------------- ----- -------= ---------------------- ------ ---- ---.---- ------------------------------- <br /> --------------------------------------------------------------------------------------- <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 8-51 Revised W-2100 <br /> w <br /> t <br />