Laserfiche WebLink
1� 97 <br /> APPLICATION FOR SANITATION PERMIT 'Permit No_ _________________ <br /> (Complete in Duplicate) <br /> 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 LOCA ION-- Q'_ <br /> f -------------- Phone---------------------- <br /> Owner's Name----------- ' `'� <br /> Address <br /> Contractor's Name. Err' �r( ''� ----- Phone------------------------- <br /> --------------------------------------------------------------------- <br /> ----- - --------- <br /> Installation will serve: Residence g?"^Apartmenf House ❑ Commercial ❑ Trailer Court ❑ ,Mootel E] Other <br /> Number of living units: -�--- Number of bedrooms I_ Number of baths/---- Lot size �PAOF �_ <br /> i - ----------------------- <br /> Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table _Oft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe I14"TH-ardpan ❑ <br /> Previous Application Made: Yes ❑ No [ New Construction: Yes ❑ No [ '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 /> Septi Tank: Distance from nearest well_________________Distance from foundation--------------------Material---------------------------------------------- <br /> ... <br /> "' ` No. of compartments----------------- --------Size--------------------------------Liquid depth--------------------------Capacity---------------------- <br /> Disp al Field: Distance from nearest well-----------------,Distance from foundation--------------------Distance to nearest lot line-______-____-_-. <br /> ,r Number of lines-----------------------------------Length of each line------------------------------Width of trench----------------------------------- <br /> Type of filter material---:-------------------Depth of filter material----------------------Total •length------------------------------------------ <br /> Seepage Pit: Distance to nearest well_-_.fir-.__Distance <br /> -_ dation__ __ ___�_.Distance to nearest to line___ <br /> [� Number of pits___.__------------Lining material__ _ Size: __Depfh__._ ______________________ <br /> Cesspool: <br /> Distance from nearest well-----------------Distance from foundation---------------.___.Lining material,_--------------------------------- <br /> ❑ Size: Diameter-±----------------------- -----.Depth-----------------.-_ . -- ----------------------- <br /> --------------------Liquid Capacity----------------------------gals. { <br /> Privy: Distance from nearest well __.._-_____------------------------------------Distance from nearest building---s------------------------------------ <br /> 0 <br /> _______._____--------.---- -_❑ Distance to nearest lot line------- ----------------------------Y-------------------------------------- <br /> Remodeling and/or repairing (describe)-------------------- -------__.-- ------____-- -`___--- " <br /> ---------------••--------------•-------------------------------------------------------- --------------------------------------------------------------- <br /> -------------------------------------------------------------------------•--------------------------------------------------------------------------------------------------------------------------------------------------- <br /> t <br /> I 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 r s and regulations of the San Joaquin Local Health District. <br /> " . 4' -- r Contractor <br /> (Signed)----------------- - - - -- --------- ---- --------- ) <br /> r <br /> ---- <br /> B --------- --- -- -- --- (Title)------- <br /> (Plot plan, showing size of lot, location of em in relation to wells, buildings, etc., can be place on reverse side). <br /> FOR DEPARTMENT USE ONLY f' <br /> APPLICATION ACCEPTED BY------ ------------------- --------------- ---------------------------------------- DATE--- "I -------------------------- <br /> REVIEWEDBY--------------------------------------------- ------------------- ---------------------------------------------------------- DATE------------------------------- <br /> BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------ <br /> F <br /> Alterations and/or recommendations:--------= ----- ------ ---------------------------------- <br /> -------------------- <br /> - -------- -------------•--------------•------------------------------------------------------------ <br /> A------------- ------------------------------------------------------------------------------------------------------ <br /> . --------- _______________________________________..___..__________________________.__________________._______-___.______.._____._.________.____________-________________-_____________- <br /> FINAL INSPECTION BY:------ __ <br /> --- - ------- --- --- te--- 1- _ ---- - <br /> i <br /> SAN JOAQUINLOCAL 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 /> E5---9-2M - Revised 1•57 F.P.CO- <br />