Laserfiche WebLink
Metadata
Document management portal powered by Laserfiche WebLink 9 © 1998-2015 Laserfiche. All rights reserved.
APPLICATION FOR SANITATION PERMIT Permit No. <br /> �� (Complete in Duplicate) <br /> ✓� Date Issued .6.---__.5.__5_3 <br /> ppli tion 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 /> s <br /> JOB ADDRESS AND LOCATION-------------- ©v U • J / /- <br /> ------------------------------------------------------ <br /> Owner's Name---------- <br /> Address ------------------------- -----O----G---.---t�-----E----- <br /> ----------------------------------------------------------- <br /> Phone <br /> --------------------- <br /> - ----------------------------------------------------------------------------------- <br /> --------------------------------------------- <br /> Contractor's Name----------------------------------------------------- -- -------------------------------------------- Phone---------------=--------------- <br /> Installation will serve: Residence 4° Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _______ Number of bedrooms __may_ Number of baths ._/._ Lot size _.__..__S ! __��r/_ _____________________ <br /> Water Supply: Public system k 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(\ Hardpan ❑ <br /> Previous Application Made: Yes ❑ No UK New Construction: Yes ❑ No Rr <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> i <br /> Septic Tank: Distance from nearest well---"--____Distance from foundation_.. Q_.-------- <br /> i <br /> __No. of compartments_______ '__..________-Size___�!� _ _47----Liquid depth_.-___'_�i.'�_'_6-4-_-_Capacity.__ _v__-___ Q <br /> Dispos Field: Distance from nearest well.._._-_-�_'r Distance from foundation-_._.-------Distance to nearest lot line_.--�.._-- Q <br /> Number of lines----------_.11-r__ _____/_�______Length of each line-----_..._-6_�..__-___..Width of trench..___.-.. ZSLt_____-____.-- N- <br /> Ix Type of filter material- _____ _! s.-_Depth of filter material ___.Total length______________------------- <br /> -_.._-..--.._-_ <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation_-_____-_.__-__-_._.Distance to nearest lot line._..._--__-_.._ <br /> c <br /> ❑ 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 /> --------------------------------------------------------------------- <br /> Remodeling and/or repairing (describe):---------- <br /> ------------------------------------------- <br /> ._._______. <br /> -------------------------------•-----------------•---------------------------------------------------------------- ------------•-------------•------------------- <br /> --- ---------------------•----------------•---•------------------------------------------------------•--------------------------------------------------------------- <br /> ----------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------•---------------------------------- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed) �--- ..__ <br /> -------------------------------------------------------------- Owner and/or Contractor <br /> BY-- ------ ----L,------------------------------------------------------------- Title <br /> -------------------------------------------------------- <br /> P of plan, s ing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY - - ------------ DATE •' <br /> REVIEWED BY ----------------------- DATE ------------------ <br /> - ---------------------------------------- - <br /> BUILDING PERMIT ISSUED ---- ----------- ----- ------ DATE <br /> Alt a_tions nd/o ecomrnendatio s:_ t, <br /> J. °L �r <br /> .,A <br /> ,a --- <br /> t�L _--- - ---• ---- ---- ---- �--- <br /> 1..�---cam -� Z ------�� ------- <br /> -=- - <br /> -- ----- ------- -------- <br /> l- <br /> -- ---r-- <br /> = � ------ ---- ----- - - - <br /> ---- ----------- ----- <br /> FINA jN,SPEC I4:..-- . --- -'-11- --------- Date ­_T ----------- <br /> ----------- <br /> �,. SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> South Ame In S 'fw 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, Califor4ayl Lodi, California Manteca, California Tracy, California <br /> ES-9-2M 10-52 Revised W-2100 <br />