Laserfiche WebLink
APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) <br /> This Permit Expires 1 Year From Date Issued Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein des4cr, 'd. <br /> This application is made in compliance with County Ordinance No. 549. Ze:e%-e_ <br /> JOB ADDRESS AND LOCATI - -- <br /> ----- ---- -- --- ---- <br /> Owner's Name-----:-------- 1), --- -------- -------------------------------------------- Phone-------------------------------- <br /> Address--------------------------------------� <br /> Contractor's Name------------------------------ --------- ---- ---- ------------------------------------------------------------- hone----------------------------------- <br /> Installation will serve: Residence /Aparfmenf House E] Commercial F] Trailer Court 0 Motel Cj Other 0 <br /> Number of living units: --- Number of bedrooms --- Number of baths I---- Lot size _51V- ---- ----- ----------------- <br /> Water Supply: Public system ❑ Community system gaPrivate El Depth to Wafer Table .6--- ft. <br /> Character of roil to a depth of 3 feet: Sand rave! E] Sandy Loam E] Clay Loam E] Clay E] Adobe F] Hardpan 0 <br /> Previous Application Made: Yes [] No [3 New Construction: Yes El No El FHA/VA: Yes E1 No El <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> r <br /> Septic Tank: Distance from nearest well__V_iistance from founclation__&_`-�rr-Material------ ------------ ------------- ------------- <br /> No. of compartments_______- Siz.__5Pxax5�----Liquid clepth---- Capacity-----9e-4----- <br /> ------------ <br /> Disposal Field: Distance from nearest well._�`------Distance from f ou ndation'__A9_4'K-r,-.Distance to nearest lot line--- <br /> Width of trench__ _`......................... <br /> R1 Number of lines________L17-P-4- Length of each line---------W------y--------- <br /> Type of filter material <br /> 4 _��/tcf Depth of filter rnaferiaI___/'_j?----------Total length--------------------------------------- <br /> Seepage Pit: Distance to nearest well______________I------Disfance'from foundation------------------_Distance to nearest lot line--.__---.--_.---- � <br /> ❑ <br /> ine_-------------- <br /> ElNumber of pits----------------------Lining material-- _-------Size: Diameter------------------------Depth------ -------------------------- <br /> I <br /> Cesspool: Distance from nearest, well________-_______Distance from foundation--------------------Lining material-------------------------------------- <br /> ❑ Size: Diameter------ -----------------------Depth----------------------------------------------------Liquid Capacity---------------------------gals' <br /> Privy: Distance from ne'aregf,well------------------------------------------------Distance from nearest building ------------------------------------ <br /> ElDistance to nearest'lot line-------------------------- -------------------------------------------------------------------------------------------------------------I <br /> Remodeling and/or repairing (describe):----------------------------------------------------------------------------------------------------------------------------------------------------------I <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> - -----------------------------------------1-----------­------------I--------------------------­--------------------------------------------- -------------------------------------------------------------------- <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)---A�. ----------j-&-.24-------- ''' '------------------------------------------------[Owner and/or Contractor): <br /> By:-----------------------------=---------------- = = ------------------------------ ---------------- <br /> (Plot plan, showing size of lot, location if system in relation to Wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT SE ONV) <br /> APPLICATION ACCEPTED BY________ ----•DATE------ ------- -------------- <br /> REVIEWEDBY------------------------------------------------------------------ ------------------------------------------------------ DATE------------------------------------------------------------- <br /> BUILDINGPERMIT ISSUED--------------------- ---------------------- ---------------- ---------------------------------------- DATE-------------------------- ----------------------------------- <br /> Alterations and/or recommendations:---------------------------7---.—----------------------------------------------------------------------------------------------------------------------------- <br /> ---------------------- -----------------­­--------------------------------------------------------------------------------------------I--------------­_­-----------------------I-------------------------------------- <br /> ---------------------------------------------------------------I------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> - <br /> -------------------- -------- ------ ------------------- ------------------ -------- --------------------------- --------- ------------ ------------------ --------- - --------- ---------------------- <br /> h44 <br /> FINAL INSPECTION BY: --------- ----- P------------------------------------- Date----71,�_ -------------------------------------------------- <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 Revised 9-'59 F.P.co. <br />