Laserfiche WebLink
APPLICATION FOR SANITATION PERMIT Permit No. .D._.--------- <br /> - (Complete in Duplicate) <br /> 0 L Date Issued _-1.-/�•- - '' <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herelp descr' ed. <br /> This application is made in compliance with County Ordinance No. 549, 5� �" 070;, 5 ` <br /> JOB ADDRESS AND LOCATION---- --------- -------- - Qom_' -??_Qr_-)____... ...�e-------�1`_�.--d---- -P-ft— <br /> ?!Z, <br /> Owner's Name -�.0 ..09------------------------•-- -- ---- --------- Phone ----• -• ---- •-•--•-- <br /> Address -------- --------------------------------- 1_.`fes$• el �� <br /> Contractor's Name----------------------------------------- ------- --------------------------------- -- ------ ----- ---------------------- Phone........................ <br /> Installation will serve: Residence D Apartment House❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other 'O <br /> Number of living units: .1----- Number of bedrooms Number of baths ._/__- Lot size ------ _1Y--- j�7..----------------- <br /> Water <br /> _--.__.-__-_-Water Supply: Public system 00 Community system ❑ Private ❑ Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand❑ Gravel❑ Sandy Loam ❑ Clay Loam E] Clay ❑ Adobe Hardpan ❑ <br /> Previous Application Made: Yes ❑ No IN 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 we11_. bistanc� from foundation <br /> Mt � !1 <br /> J No. of compartments.._.___ -------- <br /> depth......0-/--_---.__:___Capacity_- ----------------- <br /> Disposal <br /> 6p---•Disposal Field: Distance from nearest well ___Distance from foundation � Distance to nearest lot li. ?�, <br /> �J Number of lines.. — _ Length of each line___-_--9b -Width of trench --, <br /> Type ofy�filter material_. Depth of filter material '' Total length- <br /> ----- - g - ..........----- . <br /> Seepage Pit: Distance to nearest well-_ ___-.--..___Distance from foundation ..................Distance to nearest'lot line---------------- <br /> Number <br /> -_--__-_.___..-Number of pits----: ---_---------Lining material----•------------------Size: Diameter--___- _-----:Depth-------...-------------­ <br /> Cesspool: <br /> --------, -Cesspool: Distance from nearest well_________________Distance from foundation--------------.:-...Lining material-- ._._-__ ___.____. <br /> ❑ Size: Diameter.--- ------. --•--- --•---Depth----------------------------------_-----........Liquid Capacity----------- <br /> Privy: <br /> .-- ---Privy: Distance from nearest well-------------------------------------------------Distance from nearest building.......------------- -.----.._-----__1. <br /> ❑ Distance to nearest lot line--------------------------------------------------------- --•--------------------------------_------•--- ------------------------ <br /> Remodeling and/or repairing (describe) -----•. ......... ........ ..•----- •..--_-- . ......_.. ...---------_...- ------ .._.-_.-.-.., <br /> .----- -- •........ ..........•---------- :_ ......._..--•- --•----- ---------•----------- -------•------- ........----------- -----__..._ ._. ... <br /> ----.-- ----•--- -------------------- -------- -------- ------ ------- ------- -------------------- ----• ------- ----- ----- - - <br /> 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 n Joaquin Local Health District. <br /> .Signed)------- —r- - --------_-------------------------------------------------(Owner acrd/or Contractor) <br /> By:-------- ------- -------- ------- ----------------- -- -------------------------_---- ---- --------trifle)----------------- - <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FO PA ENT E ONLY . <br /> APPLICATION ACCEPTED BY.... :. __ __ ..-_----- DATE.._... <br /> REVIEWEDBY- --------------------- - ------- -- ----- -------------------- --------- DATE -- ---------- <br /> BUILDING PERMIT ISSUED- - - - _ - ------- -------_ - -- ----- <br /> Alterations dor recomme tigns:-- ------ ' <br /> ----- <br /> --- -------- ------- <br /> - --------------- - <br /> AFINAL INSPECTION BY:----- L/ - .............. Date------ -- ------- --V------------------------------- <br /> SAN <br /> -.-. _------- <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 8-51 Revised W-2100 <br />