Laserfiche WebLink
1 �r� APPLICATION FOR SANITATION PERMIT Permit No. <br /> V in D <br /> (Completeu llcate 7� <br /> p• a Date Issued -------- r <br /> Application is he y 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 LOCATION = <br /> Owner's Name------------------------------ -_ ------------------- <br /> ------------------- ------ Phone------------------------------------ <br /> - <br /> Ali <br /> ° Address ............... d��`-- - ---- .. -- --- - --- -------------- ---- ------- <br /> Contractor's Name---------- •- -�. _G?-. ._... . V *one <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other <br /> � .Number of living units: __. _ ber of bedrooms Number of'baths .1----- Lot size _______________ _" �_-----�--- -----.--.-- i <br /> 0 Water Supply: Public system Community system [-I Private ❑ Depth to Water Table508f ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ ravel E] Sandy Loam ❑ oam E] Clay [D Adobe �ardpan ❑ <br /> Previous Application Made: Yes E] 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 Ta k: Distance from nearest well-----------------Distance from foundation"_._----------._-._ Material_-_-_-_----------..-__""---_----.---.---__----.-. <br /> Septic <br /> No. of compartments---------,-,,--/-----�- /' e-------•------------------- ---Liquid depth------------ ------------Capacity----------------------- - <br /> Disposal Field: Distance from We�re,t wellYY_dCNtance from foundation_ .-�{1____.___..Distance to nearest lot Ire ----__--_- <br /> Number of lines__ Len th of each line____ Width of trench_.____r ___________________g a Type of filter mal.`S'"_ 'rDepth of filter materiaL__.�_�__________Total length___.____ . ._________._________"-. <br /> Seepage Pit: �iu�abnece of nearest well------------------------inin maDteraialce from foundation <br /> Diameter------------------Dlstance to nearest lot line---=------------ <br /> ❑ p 9 <br /> Cesspool: Distance from nearest well------------------Distance from foundation- .-.._._--.___.Lining material__.----------------_.---------._----_. <br /> (�❑ Size: Diameter-----= --------------=- ----------Depth------- �._ --------------- _----------....Liquid Capacity------.: -----: gals: U�p <br /> Privy: Distance from nearest well-_`---------------- ------------------------------Distance from nearest building--------.------_------------------------- <br /> ❑ Distance to nearest lot line---------------- ---- -- -------- -------- --------------- '---•---------------- <br /> Remodeling and/or repairing (descrilae):--------------- ---: ------ <br /> --------- - --- - <br /> - <br /> --------- - <br /> i.= <br /> � I hereby certify that I have prepared this application and that the w will be done in accordance ith San Joaquin County <br /> ordinances, Sta laws, and rules regulations of the Sa Joaquin Local He Ith'�istrict. }, <br /> f ----- `---- �� �' "�------ <br /> (Signed) (Ow . rand/o Contractor] <br /> -------------•--- <br /> BY� '-`- = ---+ - - - -- -=--------------------------------------• -------- ------------(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 <br /> ::.::- <br /> ATE <br /> REVIEWED BY--------------------------------------------- U------�- ------------------------- ----- DATE -- ----------------------- <br /> -------------------------- ------ <br /> BUILDINGPERMIT ISSUED--------------------------------------------------------------- ------ DATE----------- -------------------------------------=------- <br /> I Alterations and/or'recommendations:_____.._____________ ___ <br /> r ---------------------------------------------------------------------------------------•___--------------------`---"------------------------------------------------------------------------------------------•---------------- <br /> --------------------------------------------------------•----------------------------------------"-•--------n---------------------------j----------------------------------- --------------------j------j------------ <br /> ----------------------------------------j-------------------------------------------j------------------------------------ -----------------------------------j-------------I---------------------------------------------- <br /> --------- <br /> --------------+-----------------------------------------------•-"------".._.".-----------------------------------------------•--------•-_-------•_-_--•----__•_-_-------•------_•--_•---_---"_•------••--------•-----------_--__-- --------•_----•--••_•--_--"__•--..._-•---__-_-_-------_•-"-_._•_------------------------------- <br /> ----------"- ------------------ -- ----------- ---------------•--- .-..---------------- ---------------------------------------------------------------------------------•---------------•---•------------------ <br /> I ' _ <br /> ttt - <br /> ;Xq,1,5_? <br /> FINAL INSPECTION BY--------------- -!>- ------------- ---Date- <br /> ; <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> I Stockton, California Lodi, California Manteca, California Tracy, California <br /> r <br /> ES-9--2M 10-52 Revised W-2140 <br />