Laserfiche WebLink
Metadata
Document management portal powered by Laserfiche WebLink 9 © 1998-2015 Laserfiche. All rights reserved.
APPLICATION FOR SANITATION PERMIT Permit No. .....___...- <br /> "L'' AM(5Complete in Duplicate) Date IssuedZ :'a`--.S2 <br /> .. <br /> Applica}ion 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 <br /> LOCA T N____ t <br /> ----- ------ <br /> ---- <br /> iPhone-----------•----------------------.- <br /> ---- = <br /> Owners Name---------------- - -- <br /> Address----------------------- ---------• •------ <br /> ------------------------------------------------------ ------•------------------- <br /> , = <br /> Contractor's Name--------- - idence artment House ❑ Com Phone___________________________________ <br /> Installation will serve: Res' p mercial ❑ Trailer Court ❑ Motel El Other ❑ <br /> Number of.livin units: _ -__._ Number.of bedrooms __ m6er of baths _/__. Lot size _____-.. -` s�- - ----------------------- <br /> 9 _ <br /> Water Supply; Public`system ommuriity, system ❑"'Private ❑"Depth to Water'Table _._:_,__ ft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam ❑ Clay Lo�arn ❑ Clay ❑ . Adobeardpan ❑ ° <br /> ' # <br /> Previous Application Made: Yes T ew Co Fstructivn: Yes <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: ' <br /> p n within 200 feeet.) <br /> tic Tank: x is tank cesspool petted if pu lic sewer i available foundaon.-.( -- _--. �apial_____ ________ __________ .____No se . <br /> '- ,Se Distance from nearest We � Distance frsmSize- < is Liquid depth Capacity.No. of compartments----- ___.._ <br /> €. t _... <br /> 4.7 <br /> Disposal Field': Distance from nearest well is#ance from foundation----------- Distance to nearest lot linal <br /> Len th of each line?" _ ----Width of trench__ <br /> Nber._of:lines:- +__ --------- 9 <br /> X um - <br /> ;Ypeiof filter material.--- Depth <br /> o ��..., �-� �....:.... . Total length <br /> De th of filter material__ + <br /> Seepage Pit., . Distan e to riea�est well------------- - Distance fror7found __..Distance to'nearest !ot line"_-______-_____-. <br /> Size: Diameter-------------- Depth th---------------------- <br /> ❑ Number of pits-------------------Lining material----------4--!e <br /> Cess ool' Distance from*foundation----------._--.----Lining material------------------_----_--_----___--. <br /> ❑-- Size:Diameter-nearest well--------------- Depth------e'er`""`---------------- -- ------------- <br /> El <br /> ----------- Liquid Capacity gals. <br /> Priv <br /> Distance from nearest well.______..__"_____ _ -_-_ :-_-_---._�_--Distance from nearest building----------------------------------------- <br /> - <br /> Y'. �.ti' w — -, <br /> ❑ _ -,Distance to nearest lot line------'-------------------------'------------------ <br /> •- ----------------------------- <br /> t . . <br /> Remodeling and/or repairing (describe)=-------------------------------------- ------p---- --- <br /> ----------------------------------------------------------------------------------------------------------------------------------------------»._-----.____----_- <br /> ______________________ _________ _____________ - <br /> y ---------------------------(------------------.-------------------------------------------__---_------_--_._._--------_-_--__----- <br /> T <br /> ______ __-._--.___*------- --------------------------------------il___-------._-_-_----_--.-----_-_-_-'n-,._--------__-.----___----------___._--------."_______________.___._____.____._-_"____..___________. <br /> _ I t ,� r � r-� t <br /> I herel rcer#ify-that.I have prepared-this application and.that.the work will be-done;in accordance with San_Joaquin County <br /> ordinances, State iawsFand rules and regulations of the#San Joaquin Local Health District.' i <br /> r { <br /> ----- ------------- ---------- ----- -- ------•--- <br /> ___-_._ Owner and/or Contractor) <br /> ..------------------------- -------------------- -----------=-------- ---------------------------- <br /> e <br /> (Plot plan, showing 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-------------------------/ �----- :- ------------------------------------ <br /> -------------- DATE <br /> REVIEWED BY----------- -------------- ------------- -- ----------------------------------- -------------------------------------------- DATE---•----------------_-------- --------••------------- <br /> - <br /> BUILDING PERMIT ISSUED---------- ------------- -------------•---...------------------------_----------- ------ DATE--------------------=----------------------------=---•----- <br /> , <br /> ecommendations------------------------------------------------- --------------------------------------- -= .. <br /> ------------------------------- .---------------------------------- <br /> Alterations and/or..r <br /> ------------------ <br /> --•---------•----------------- ---------- •------------ <br /> i -------- ---------------------------------=---------------------------------•------------------------------------------------- <br /> - <br /> --------__�----------• =--- <br /> - -------- ------------------- <br /> _- _- __________-------------________________ i <br /> ------------------ <br /> ------------------------------------------- -------- � <br /> -------.._. -------.-------_ ------ --•----•------- <br /> s� <br /> ------------- -------------------------------- <br /> � -T�-r- -�------ � - .Date------- -��--------- - - <br /> FINAL INSPECTION-BY:-_--,�-.--------------------- <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 <br /> Lodi, California Manteca, California Tracy, California <br /> E5-9-2M ; ' Revised W-2100 <br />