Laserfiche WebLink
APPLICATION FOR SANITATION PERMIT Permit Nod__�____ <br /> (Complete in Duplicate) Date Issued ----- <br /> Applica-lion is hereby 'Made to the San'Joaquin Local Health District for a permit to construct and install the work herein de ribed. <br /> This application is made in compliancq.�,w4.County.Ordinance No. 549. <br /> 41' fYC <br /> Hs E, <br /> ---- ---------------- ­_­------- <br /> /W -- ---- <br /> JOB ADDRESS AND LOCATION---- ------- <br /> Owner's Name----------- -------------- ---------------------------------------- -----------------------------------------... Phone------------------------------------- <br /> ---------------57�zXr ----------­-- ---------- ­--------------- <br /> /01,10 -e---V <br /> Address------------------------------ <br /> ---- ---------------------------- Phone, ---Ak77- <br /> -------------- <br /> Contractor's Name--_--k-------------------------- <br /> Other El <br /> Installation will serve: Residence V Apartment House E] Commercial E] Trailer Court E] Motel El <br /> 41 - <br /> Number of living units: j.___- Number of bedrooms -.3--- Number of baths Lot size --------------- <br /> ......... . <br /> Water Supply:' Pu6licisystem El Community-- system [I Priv'afe'W Depth to Wafer Table*,97 ft. <br /> Character of soil to a dipfh of 3 feet: Sand E] Gravel El Sandy Loam E] Clay Loam El Clay El Adobe ' Hardpan 0 <br /> Previous Application Made: Yes E] N I o New Construction: Yes E] No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic fank;or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank, Distance from nearest well________________Distance from foundation-------------------Material------------------------------------------------- <br /> F1 OF*I irl AtCl No. of corriparfm' en'ts--------------------------Size---------------------------------Liquid depfh--------------------------Capacity------------------ <br /> foundation--------------------Distance to nearest lot line_______:_______. <br /> ❑Disposal Field: Distance from nearest well________________Distance from <br /> oy Number of lines---------_-----------------------Length of each line------------------------------Width of trench----------------------------------- <br /> Type of filter material________________________IDepfh of filter material-----------------------Total length_____--________..__________._:______-.__ _ <br /> See <br /> ength--------------------------------------- <br /> See e Pit: Distance to nearestowell--- _4V--------Distance from f8U'ndation_..;7___% ----_.Disfaue to .nearest lot line-44 <br /> Number of pits--Q` Lining .7_-----------Depf1h__ ------------------- <br /> --------- Li material-B/21 Size: Diameter---- <br /> :-Distance from foundation___________-;------Lining material-------------------------------------- - <br /> ____Li <br /> Cesspool: Distance from nearest well--------------- <br /> 171 Size: Diameter- ------T--------- -=-----------------Dept h-------------------------------------------- --------Liquid Capacity-.-----------------------I---gals. M <br /> i Distance from nearest-building------------------------------- -- ----- <br /> Disiance from nearest well--------------------------------- <br /> ----------------- <br /> Privy: <br /> Ej --Distance-to,nearesti lot;1i6e_ - ------------------------ -------- ------------------------ --------------------------------------------------------- -- _J� <br /> -------- ---_----------_ <br /> Remodeling and/or repairing (describe):2_f - <br /> - - - -- <br /> ----------- <br /> -----------------1.------------- ------ - - <br /> ---------------------------- -------- --- <br /> ........................1�------- <br /> ----------------------- -------------- ------------------------------------------------------------------------1­1--------------- ------------ <br /> - - t - I I � ------------------------------i----------------- -------------------------------------------------------------------------------- <br /> -------------------------------------------------------------------------------------------- <br /> Ir County I hereby certify-thati-b ve prepared this application-and that the work will be done in accordance with San Joaquin Co n y <br /> ordinances, State law , and ru s and regulations of the'San Joaquin Local Health District. <br /> (Signed)----------------------- and/or Contractor) <br /> By:---------------------=i----- I------------- <br /> '000 side). <br /> (Plot plan, showing size of lot, location of system in relation tow& <br /> FOR DEPARTMENT USE ONLY <br /> --------------- <br /> APPLICATION ACCEPTED BY-------- -------- ---- --- ---------------------- --------- -------- - - DATE <br /> --------------------------- <br /> ---- ------------------ ----------------------------------- <br /> REVIEWED BY--------------------- ----------------------------------------- ------------------ --- --------------------------------- DATE <br /> - <br /> BUILDINGPERMIT ISSUED----=--=-------------------------------------------I---------------------------- --------•I-------------- DATE-----------__-------------------------------------------- <br /> Alterationsand/or rec;mmandations:-------i-------------------------------------- ---------------------------------------------------------------- ------------•---------------•---------- <br /> - <br /> --------------------------------------------------------------------- <br /> ---------­---------- <br /> ------------------------------------------------------------------- --------------- --------•----•---------- <br /> ----------------------------------I--------------------- ---------- ----------------- --------Z.-:---------------------------- -----------------------------------------------------------------------------------I----------- <br /> ---------------__---------------------------------------- <br /> ---------------------------------------I--------------------------_______________________-______________________________________________________________ <br /> ----------_ <br /> j -------------- :-------------------------------I—--------------------------------- <br /> ------------------------------------------________________________f-_______._.-._-____-.__.__----------------------------------------- <br /> -Date---- --- <br /> FINAL .. — �L_ _------ ------------------------------------- <br /> FINAL -INSPECTION-BY:-------__ <br /> BY:--------�'._�4 � -------- -------------------- ---- <br /> 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 /> PC-0-1)" RAv;t^e1 W-2100 <br />