Laserfiche WebLink
APPLICATION FOR SANITATION PERMIT Permit No. _____ <br /> ._. ��_l�_ <br /> � �- <br /> (Complete in Duplicate) / <br /> Date Issued ____ <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 compliances with County Ordinance No. 549. <br /> JOB ADDRESS A L A !_._®C1 _____•_��_:----------- 1---� <br /> Owner's Name----------............. ! --------------------------------- -- -' `---------------------- Phone.................................... <br /> Address------- <br /> _.___ _ <br /> S Z' -*"' fes! ft <br /> ., <br /> ---------------------- <br /> Contractor's Name---•- - . ._...._•_.. .. �R ------ Phone................................... <br /> will serve: Residence partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ________ Number of bedrooms _______ Number of baths -------- Lot size ____________________________________________________________ <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 ❑ Clay Loam ❑ Clay❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: Yes ❑ No New Construction: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well__,_______________Distance from foundation--------------------Material______________________-__:________--__-__-______- <br /> ❑ No. of compartments---- --------------------Size--------------------------------Liquid depth-------------------------Capacity......... <br /> Disposal Field: Distance from nearest well-----------------Distance from foundation.___:_______________Distance to nearest lot line................. <br /> ❑ Number of lines-----------------------___---------Length of each line------------------------------Width of trench................................... <br /> Type of filter material------------------- -----Depth of filter material____-__..____________Total length___-_________-____________________________ <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line_____-_-_________ <br /> ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-------------- --------Depth____-___-____-__-_____-_________ <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material---___________________-______�___. <br /> ❑ Size: Diameter---- -- -- -------------- ----- p ------- ----- - ----__Liquid Capacity.-..----�-- ------------gals. <br /> Privy: Distance from nearest well---- ✓ -- <br /> ------ from nearest building___,,4_­'_e_7/ <br /> [err✓ Distance to nearest lot line_______ _ <br /> Remodelingand,/or repairing (describe):__--_ ________ ________ _ __ <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) I -_------- .4 - (Owner and/or Contractor) <br /> --------------- <br /> By:. <br /> Title <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------- DATE----- Jam_ <br /> REVIEWED BY-------------------------- DATE-----�j-_-='---•------------._.------------------------- <br /> --------- <br /> ------ <br /> BUILDINGPERMIT ISSUED------- ------ - --V- ------------------------------------------------------------------ DATE............................................................ <br /> Alterations and/or recommendations--------------------------------------------------- <br /> ------------------------------------------------------------- -----•------ ---------•-----------•----•--------------••-----•----••-•--------•--•-----•--••-•-•----•------••••-•------•-- <br /> --------•---------------------------------------------------------------------------------------------------------- -------................................................................................................ <br /> -----------------------------------------------------------------------•- --- ....................................------------------------ ---------------------------------------------------------------- -----••-- <br /> FINAL INSPECTION BY:__-___ — /- C� <br /> - -------- -------- - ---- - -------- Date---------- -•- --- -- --------- <br /> SAN JOAQUIN LO AL 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 145446 ATWOOD <br />