Laserfiche WebLink
Metadata
Document management portal powered by Laserfiche WebLink 9 © 1998-2015 Laserfiche. All rights reserved.
FOR OFFICE USEE: <br /> _4 "L-l� <br /> --------------------------1:?7Az._4 y.,__/,! VS APPLICATION FOR SANITATION PERMIT Permit No. ©... <br /> ------------------------- -------------- ---------------- (Complete in Duplicate) <br /> --------- This Permit Expires 1 Year From Date Issued 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 AND L�OCATI`ON.---- --- <br /> Owner's ................. - Phone.................................... <br /> Address................-•• -- ------------------------------------------------------------------------------------------•-------------------------•-------------------.-- <br /> T <br /> Contractor's Name...C� --... ---•--•------------------------------------------------- ......................................... Phone................................... <br /> Installation will serve: Residence gEr �Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ---I--- Number of bedrooms __3__ Number of baths _1... Lot size __.. t „ ..__ ......................... <br /> Water Supply: Public system Community system ❑ Private ❑ Depth To Water Table IQ ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe1_9--TTardpan ❑ <br /> Previous Application Made: (If yes,date--------------------) No New Construction: Yes [f""N'o ❑ FHA/VA: 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./O.�_.........Material-----/a----------------------------------- <br /> No. of compartments ° _Ca aci ! <br /> P 2---------------Size-•-•----�--=X-a�-�---Liquid depth----•-�--...---•------ P tY•--��.�-- <br /> R <br /> Disposal Field: Distance from nearest well_-_it.-__-_.-_Distance from foundation.Z.0.............Distance to nearest lot line..____..!._.... <br /> [[ Number of lines.--2-�_.... ---------Length of each line___'�!b__.__..............Width of trench.....��!-_�____--.----------- <br /> Type of filter materia _Gt. ----._-Depth of filter material_./$`_...........Total length..._ZO.-d._......................... <br /> Seepage Pit: Distance to nearest well----_"""'-----------Distance from foundation..Zo.............Distance to nearest lot Iine.ST_�.._..._ <br /> Number of pits---2—-------------Lining material_ til-G_-It------Size: Diameter-_-_�47-----------Depth-------0---47�.._..______. <br /> Cesspool: Distance from nearest well-----------------Distance from foundation-----.--------------Lining material..................................... <br /> ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------_Liquid Capacity............................gals. <br /> Privy: Distance from nearest well ___--_.___-______________________._- -------Distance from nearest building.......................................... <br /> ❑ Distance to nearest lot line---------------------------------------------------------------------------------------------------------------------------------------------- <br /> Remodelingand/or repairing (describe):-----------------------------------------------------------------------------------------------•---------------•---------------•----•----•-----•---•---- <br /> -----------•-----------------------------------------------------------------------------------------•----•-•-----------------------------------------•--------------------------------------------...-------------•----••---- <br /> ---------•----------------------••------•-----••--------••----•--------•-------------••--••--.-------------•--------------•-•-------------------•--•-----------------•------------------•-•--•-----•-----------••----------- <br /> ------------------------------------------------4prepared <br /> -------- -------------------------------------------------------------------------------------------------------•--------------------------------------- <br /> I hereby certify that I ared s pplication and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and re a ' ns oft a San Joaquin Local Health District. <br /> (Signed)--------------------------------- - -- - ---- (Owner and/or Contractor) <br /> By:--•--------------•----•-------- -------------------------------------------------------------------(riitle)---------------------------------------------- -- ----------- <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•. <br /> REVIEWEDBY-------------------------------- ------- ------ DATE------------------------------------------------------------ <br /> BUILDINGPERMIT ISSUED---------------------------------- -------------------- ...................................... DATE........................... ------------- <br /> Alterations and/or recommendations:_,1 -.-..1-1-= '---- -- ---1-----------LtL <br /> -------------------------------------------------------------------------------------- ------ <br /> -------------------------------------------------------------------------------------------------------------------•--------------••-•--------------------•......-•----------••--•--------•----•-----------•-------------••-- <br /> -----•-•----------------------- ------------- -----------------------------------------------------------------------------------------------------------------------------•-•----•---------•-------•--------••--•---------- <br /> -------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------•----------••--- <br /> FINAL INSPECTION BY:.__... _ ��. --__ Date <br /> -- '- -----'- --------�---------------- -•----- .�_� <br /> • ._./.__-__. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Srreet 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 8-59 2M 5-62 ATLAS <br />