Laserfiche WebLink
ry rVK f <br /> SE- <br /> ------ ---- - --- �// _ APPLICATION FOR SANITATION PERMIT Permit No.---------------------- <br /> --------------- <br /> (Complete in Duplicate) <br /> --""""""- -------- -- -- This Permit Ex fres ] Year From Date Issued <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 A D L CATION__ g <br /> Owner's Name...__--.. <br /> f . <br /> - ----------- <br /> Address <br /> --------- Pz------ hone <br /> A ress._.---_-_-- <br /> - - ------------••---- <br /> ---------•--------•- - -- ----------- <br /> Contractor's Name.--. <br /> _N ........T4 <br /> Installation will serve: Residence Ua-'Apartment House [3Commercial E] Trailer Court C] Motel ❑ Other ❑ <br /> Number of living units: __2�. Number of bedrooms . -- Number of baths A-- Lot size ...., 4 X_-�•2 6'....... <br /> Water Supply: Public system {Community system ❑ Private ❑ Depth to Water Table`. }ft. <br />' Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Ej Clay Loam Ej Clay ❑ Adobe M"*Hardpan ❑ <br /> Previous Application Made: (If yes,date--------------------) No New Construction: Yes [U'* No ❑ FHA/VA; Yes ❑ No Rd� <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No sep1tic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septi nk- istance from nearest well------ ---------Distance from foundation_--_.-._-- ._--- <br /> -• --.Material__.-----••---•-----••........................•--� <br /> o. of compartments---- ------------------Size--------------------------------Liquid depth.-..----------------------Capacity <br /> Dispose field: Distance from nearest well---` ""_-Distance from foundatio P <br /> i <br /> �. _-__.--.Distance to nearest lot linet�.___...._. <br /> -", Number of lines___________ ___"----"--" Length of each fine___--"- ---_---"_ <br /> Gam' ..Width of french..- <br /> Ty <br /> Type of filter material. _----Depth of filter material"rlp--- - length---.. <br /> Total ' ---:.--•--- `�f <br /> Seepage Distance to nearest all ------- Distance f m f undation_�.---_--__-.Distance to nearest lot line <br /> � `�` <br /> Number of pits""--.--I.- --------Lining material......h-�----Size: Dia meter-.� .," <br /> Cesspool: Distance from nearest well------------- ----------Dept Distance from foundation"-_-"- "-----_"--_-.Lining material_-."._-.--..."__--.-"_--..--..- <br /> ----- <br /> ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------- <br /> -'--- ---------------Liquid Capacity els. <br /> ------•----•------------•-9 <br /> Privy- Distance from nearest well"--"-"--------------------_._-----.._----- ._Distance from nearest building <br /> Distance to nearest lot line-- "---_.-----"-.---"_----_" ." <br /> Remodeling and/or repairing (describe)----------------------- <br /> ---- <br /> u <br /> - hereby <br /> ti '- - I - --- --are this <br /> --- -----------------------------------•------------•------------------.--------------------------........ --.----•------------------- <br /> I hereby certify that I have prepared this eel' ation an ,that the work will be dons in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regale o the San oaquin Local Health District. <br /> (Signed)9 ) - ---------------------------------------------- --- -------------{Owner and/or Contractor) <br /> ------------ <br /> .......... <br /> relaion to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----:_/.., -- -----_� ----____--_- - DATE..- <br /> REVIEWED BY — <br /> - ----------------------------------- -- <br /> -- - ------------•------------ <br /> ----- - --------------- - DATE-------•---- •-•------ <br /> BUILDING PERMIT ISSUED _________ <br /> -------------- -------- ---------------••-•---------•---------------. DATE.------•-'------ <br /> Alterations and/or recomme dations:------- } <br /> ,� <br /> ---------------------ot­ ------------------ <br /> ------ ----- <br /> FINAL INSPECTION BY:,. .. j <br /> ------ Date----- r ` .-------------------------------------------------------- <br /> S <br /> � Z <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 west Oak 5neet <br /> 144 Sycamore Street <br /> Stockton,California 405 West 9th Street <br /> Lodl,California Manteca,California Tracy,California <br /> E6 9 gEV13EU S-S9 pM 5-61 ATLAS <br />