Laserfiche WebLink
v1� <br /> APPLICATION FOR SANITATION PERMIT . Permit No. . <br /> (Complete in Duplicate) <br /> Date Issued <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 Or ' ante No. 54 . <br /> JOB ADDRESS AND OCATION______ ____.,(_. <br /> Owner's Name----------01` 4 !f� ' Phone-Q. _,' SX.. <br /> Address------------------ ` j <br /> Contractor's Name ------ ---------- ----------------------------------------------------------------- Phone/- - r✓ <br /> Installation will serve: Residence E] Apartment House ❑ Commercial E] Trailer otel ❑ Other <br /> Number of living units: __-�_. umber of bedrooms ---I--- Number of baths .. __ Lot size -- ________ ------ �.__ ---t................. <br /> Water Supply: Public system [Community system ❑ Private ❑ Depth to Water Table sSQ_ ft. <br /> Character of soil to a depth of 3 feet: Sand Gravel E] Sandy Loam E] Clay Loam E] Clay 171Adobe Hardpan ❑ <br /> Previous Application Made: Yes [-] No New Construction: Yes [9--'No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) /� <br /> Dista ce�f rom foundation__-. �..+-----.Material.4--1:,-�4"1 4_' - ------------ <br /> Septic Tank: Distance from nearest well_____' r_ j� �•.y �y <br /> No. of compartments_._-__., --------Size �s.__3�n_Liquid depth._.-.7_(i-_..______.Capacity...._�---------------- <br /> 9Kd <br /> Disposa ield: Distance from nearest well____ ____Distance from foundation----P?-O! ._.Distance to nearest lot line----- I_..... <br /> E Number of lines......... j y�__.�_Length of each line________v�._�/y. '. <br /> Width of trench--------.2 f.. <br /> Type of filter material_l •�._t/ ._Depth of filter material___._1._9..__-___.Tota! length.__. ......................I_ <br /> Seepa Pit: Distance to nearest well------f--------Distance f�or�n un ation___.., Q__._....Distance to nearest lot line.�__�_,�____ <br /> Number of pits-__--_-I-------------Lining material-..__(---I----. -_-- .Size: Diameter-_-� _------Depth----- --_--___----_--_ <br /> Cesspool: Distance from nearest well----------------- from foundation-----.--------------Lining material--------------------._.-----__-__-__-. <br /> ❑ Size: Diameter-------------------------------------Depth.---------------------------------------------------Liquid Capacity--------------------------gals. <br /> Privy: Distance from nearest well-------------_-----------------------------------Distance from nearest building------------------------------------------ <br /> F1 <br /> ._-_----_--_--- ____________------..-._.❑ Distance to nearest lot line---------------------------------------------------------------------------------------------------•--------•---------------- -------------- <br /> Remodelingand/or repairing (describe):--------------------------------------------------------------------------------------------------------------------------------------------------------- <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 rules and regulations of he San Joaquin Local Health District. <br /> Si ned --------------------------------------------- and or Contractor <br /> KJ <br /> ( 9 )----•-•---------• ) <br /> By:----------- ------(rifle)-- -------------- -------- <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 13";_ <br /> - - ---------------- ---------------------------------------------------------------- DATE�--•--'----•---- ----------•-••------------------- <br /> REVIEWEDBY------------- ------------------- -- -------------------------------------------------------- ----------------------------- DATE--d°' ----------------------------------- . <br /> 16 <br /> BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE---- ------- ------------ <br /> Alterationsand/or recommendations:----------------------------------------------------=......................................-----------------•-----------------•------------------------------. <br /> ------ ------------------- ........................... ------------- ---- <br /> �� <br /> -- - <br /> -----, - ------------------------------------------------•------------------------------......................--------------------------------------------------- <br /> . ---------- ---------------- ---------------------------------------------------------------------------------- - ---------- <br /> FINAL INSPECTION BY:.. PE���__ ---------------------------------------- Date-------.-.Ls"" ----------- ------------ ----- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT, <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street D <br /> Stockton, California Lodi, California Manteca, California Tracy,California c <br /> ES-9-2M ; Revised W-2100 <br />