Laserfiche WebLink
rUK UrNU <br /> ---- -----------------C"��------ ------- 2- <br /> --------------- .... APPLICATION FOR SANITATION PERMIT Permit No. ........... <br /> --------------------------------------- (Complete in Duplicate) / <br /> ------------------------------------ ----------- --------- SCANNECOate Issued ---- <br /> This Permit Expires 1 Year From Date Issuid <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 /> (qe <br /> JOB ADDRESS AND LOCATION.---3-3--- -------- 0 <br /> ---- <br /> ----------------- ------------ ----------------------------------------------------------------------- <br /> Owner's Name..-- -------- --------------­----------------------------------------------------- Phone <br /> --- --------- <br /> Address-••------ <br /> Contractor's <br /> ddress­.------- <br /> Contractor's Name------ ----------------*---*---------------------- <br /> ­- ---------- 3.- <br /> --------T -------------------*------------------1-1-------•------------------------------------- Phone.................................. <br /> Installation will serve: Residence EL--Apartment House E] Commercial E] Trailer Court E] Motel [-] Other [3 <br /> Number of living units. Number of bedrooms -�­ Number of baths __.I...- Lot size <br /> Water Supply: Public system M--communify system [] Private' E] Depth to Wafer Table 0-- ft. <br /> Character of soil to a depth of 3 feet: Sand El Gravel [] Sandy Loam Ej Clay Loam E] Clay E] Adobe[j-'Fqardpan E] <br /> Previous Application Made: (if yes,date--------------------) No El--' New Construction: Yes <br /> ff"No El 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 /> Sept'�Tanlkr: Distance from nearest well-----------------Distance from foundation--------------------Material--------------------------------------------- <br /> No. of compartments-------------------- <br /> ---Size----------------------------:---Liquid depth--------------------------Ca acit Dispo al Fielij, - Distance from nearest well-----------------Distance from foundation------------­------Distance to nearest lot line.....-------.--- <br /> Number of lines-----------------------------------Length of each line--------------------------------Width of french-------------- <br /> Type of filter material----•--------------------Depth of filter material-----------------------Total- length------------------------------------------ U <br /> Seepage Pit: Distance to nearesfr7elI'-1-7j1Cf�-(-- Disfancejmgn Distance to nearest lot line...`'._....-..-._ <br /> Number of pits- VM <br /> -----------Lining material----------kok-f.­Size: Diamefer­-A?��--------Depth- -------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation-------------------Lining material-.---.._._--.-------._.------------._.Size: Diameter--------------------------------------Depth---------------------------------------------------Liquid Capacity-------------- -------------gals, <br /> Privy: Distance from nearest well----------------------------------------------------Distance from nearest building------------------------------------------ <br /> 0 Distance to nearest lot line-------- <br /> Remodeling <br /> ine--------Remodeling and/or repairing (describe):...-_--------------_ ----------------------------------- <br /> ------------------------------------------------------------------------------------ --------------------------------------------------------------------------------------------------------------------------------------- <br /> - ------------------------------•--•-----------------------I------------------------------------------------I---------------------------------------------------------------------------- <br /> I hereby certify that I have prepared this applicifion and that the work will be done in accordance with San Joaquin County <br /> ------------------------------------------------------------------------------------------------------------------------- .- <br /> ------------------------- ------------------------------------------------------------ordinances, State laws, and rules and regulations of the Sa Joaquin Local Health District. <br /> (Signed)---------------------------------------------------------------------------------- .......I--- ----------------------------------------------------------------(Owner and/or Contractor) <br /> BY:---------------------------------------------- ------ --------- - --- -- ------------- -----------------------------------------(Title)------------------------------------------ ................. . <br /> (Plot plan, showing size of lot, location of stem i of <br /> to wells, buildings, efc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--------------------- -----------I---­---------------------.- DATE <br /> REVIEWEDBY---------------•--------------------- ---------------------------------------------- DATE <br /> BUILDING PERMIT ISSUED------------------------------------ <br /> ------------------------------------------• <br /> -----------------------------------------I DATE <br /> Alterations and/or recommendations:------------------------------ -------- ----------------------------------- <br /> ----------------------------- ----------------------------------------------- ------------------------------------ -------------------------------------------------------------------------------------------------------- <br /> ------------------------------------- ------------------------------------ ------- --------------------------- ------------------------ ----------------------------------------------I------------------------­­----------- <br /> -------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------­­------------------------------------------- <br /> --------------------------------------- -------------- -------------------------- ------------------------------------------------------------------------------------------------------------------------- -------- <br /> FINAL INSPECTION BY:,-- .... ......... --- --- ----------------- ---------- Date—. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,Cailfornla <br /> CS-9 REV1OEO 9-59 r.P.00...11-11. <br />