Laserfiche WebLink
�1 APPLICATION FOR SANITATION PERMIT Permit No, ....... <br /> (Complete in Duplicate) Date Issued . _1__ �� <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 Ordin ce No. 549. <br /> JOB RESS LOCATI -? -r - -- -"` Y <br /> ' N ��� cam'._ - <br /> Owner s a e ---= ' ` - - - c o-J <br /> , ) --------------- Phone-------- -------- - ----------- <br /> Address - 'T_.1 =-� _ <br /> Contractor's Name------------ ----- -- •-----.................................................----------------- ---------------------------------- Phone----------------------------------- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Tra'�erWolMote❑ OtherNumber of living units: .-.. Number of bedrooms .. Number baths- _ ._ x `?L <br /> Water Supply: Public system ❑ Community system ❑ Private Depth Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand P Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Com. <br /> Previous Application Made: Yes ❑ No New Construction: Yes No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: _ <br /> (No septic tank or cesspool permitted if pyblip �ew*r,'s available within 200 feet.) <br /> Septic T��,k: Distance from nearest wel �.. _' 9 fro f�itndat��..._�_ e i�nl � ` ` 'O <br /> No. of compartments--. •----K-------'Si � x�� xd (� <br /> P Liquid yleptn= Capacity �� l <br /> Dispos Field: Distance from nearest w f�__5_0------- ance from foundation_1 ;� ,stance to nearest I t I. <br /> 1011 Number of lines---------- -. trench-- �------------- <br /> ____�__�__,_�_,_,_,,__y_ __Length:of-each line______.__ /_c�__�_r__.V�i"dfih of :.__.!u_�" <br /> of filter materi S v" - p - r g 1 l <br /> Depth of filter material_.._.__.__ ----------------- <br /> ------Total; length-. <br /> Seepage Pit: Distance to nearest well---------------------- from foundation-------------°.___.Distace4o nearest lot line----------------- <br /> ❑ Number of pits---------------------Lining material-----------------------Size: Diameter__---.•-•-.-- ---------Dept h--------------------.------------ <br /> Cesspool: Distance from nearest well_________________Distances from foundation---.----------------Lining material_.---------.------------------.__---- <br /> ❑ Size: Diameter--------1-------------------- --------Depth------•----•----------------------------------...Liquid Capacity-.--------------------------gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from neardst building--__._.____._------.•_____._.--_--____.. <br /> ❑ Distance to nearest lot line----------------------------------------------------------------------- ---------------•------------------ --------------------------------.. <br /> Remodelingand/or repairing (describe):-------------------------------------------------------------------------------------------------....................................................... <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------•--------------- <br /> ------- -------------------------------------------------------------------------------------------------------------•-----------------------_-----------------------------.------.----------------_------------------------ <br /> I hereby certify that I have prepared this application and that-tke work will bt donb in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)-;gg,-,� --=---- yr -r�.2� _' - �- '' ' - -------- •- ------ -------- (Owner and/or Contractor) <br /> By:----------------------------------------------------------------------------------------------------------------------------------(Title)_.---- ------------- <br /> ----------- <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 /> REVIEWED BY --------------------- <br /> ---------------------------------------------- DATE; <br /> BUILDING PERMIT ISSUED----------- ------------- DATE.. --------------------------------------------- <br /> Alterations and/or recommendations:--------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------------............................................................. <br /> ------------------------------------------------------------------------------------- -------------------------------...-------------------------------------------------------------------------------------------------- <br /> -----•----- ----- <br /> ,, <br /> -------------- ------------------------ -------- -------- -- --- ---------------------- -------• ------------------- <br /> FINAL <br /> ------------ ---FINAL INSPECTION -- ---- - --------------- ------ Date...... <br /> / ''1— 1 D � 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 0-52 Revised W-2100 <br />