Laserfiche WebLink
APPLICATION FOR 1 SANITATION PERMIT Permit'No. "�-�------------ <br /> 1 i (Complefe in Duplicate) A' <br /> `r Date Issued <br /> Application is hereby made to the San Joaquin Local Health District fora permit to construct <br /> This application is mA�i�o lian with County Ordinance No. 549 p uct and install the wo:k herein described. <br /> t <br /> JOB ADDRESS ARID LOCAT 0__�- U d-0,- "0 , <br /> x 'L" <br /> • Zile- -�" <br /> Owner's Name. -_"- _ _ <br /> ----------------- �.Q_.f <br /> --------- ------------- <br /> Loll <br /> Address--- - <br /> SKe - Phon -� <br /> --- -- - <br /> - ---�••----- ---• . __ --- 7z-- " .. <br /> 0..+ <br /> ----------------------- - <br /> _____ ___ <br /> Contractor's Name_______ <br /> - Phone"- .� <br /> - " <br /> Installation will serve: Residence [V Apartment House ❑ Commercial ❑ Traile'r Cotirfi <br /> f ❑ Motel ❑ ,Other ❑ <br /> Number of living units: ---I--- Number of bedrooms _ _ Number f baths "-� Lot size _"-_/ <br /> Water Supply: Public s "!� _ <br /> stem <br /> y E] Community system ❑ Private D`ep. to 1Wifer Table _-."___• ft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel E] SLdy boom LI, CI_a' Loam Clay Y ❑ y ❑ Adobe Hardpan ❑ <br /> Previous Application Made: Yes ❑ No V New Constructio Ye�[� o ❑ J <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is ailabl! with'i 200 f��P%4_..Ma <br /> Septic nk: Distance from nearest welf�� �-" "-____Distance from fou tion_" te ick!" ± .`-. .gl-- <br /> No. of eomparfiments_ sizx, E -{ LiglJj4�epth------ `''� <br /> ---- ----- Capacity " <br /> Dispos Field: Distance from nearest w 1!. _""Q- i / 1 "" <br /> is ante from fo_upc�tin_It <br /> __ _`,Distance to nearest lot li e{�__es`6{s <br /> Number of lines----__-_-- _F -- -------------- -Le gth of`eAchffne_-- --IT_ Width of trench... <br /> Typeof filter materiai.•_ _f """ <br /> YJr-"" De fh of`filter material-----___J_ I /� <br /> Total length --------4-�`--------------------� <br /> Seepage Pit: Distance to nearest welt----------------------Distance from foundation--------------------Distance to nearest lot line____-.-_""""._"_ <br /> ❑ plumber of pits----------------------Lining material---___------ -- " Size: Diameter----------------------- <br /> -�.- --- � Depth---------- ----------------- --- <br /> Cesspool. Distance from nearest well----------------"Distance from foundation_--_--__----"-----.Lining material_-.__-_______-.________ <br /> i <br /> ❑ Size: Diameter--------------------- -- -".. <br /> --- -- -----Depth---------------•----•--------------................Lrquid Capacity- --- ---------------------gals. <br /> Privy: Distance from nearest well" _-__ --- -------------Distance from nearest building <br /> --------- -- <br /> Distance to nearest lot line <br /> ---------------"""-- " -"___--`___ <br /> ------------------ <br /> Remodeling and/or repairing (describe):_ <br /> --------------------------------------------•---------------------•-•-------------------------•-------------------------------------------------------------------------------------------------- --------- <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, Sf law , and rules and regulations of the San J uin Local Health District. <br /> (Signed „'11---------- �► <br /> ------(Owner and/or Contractor) <br /> """-" / <br /> By: -----------•------- ---- Title <br /> g P <br /> (Plot pian, showing size of lot, location of system in relation to wells, buildings, efc., can be laced on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ------------------------ <br /> --------------- DATE" <br /> REVIEWED BY------ -----------------•-------- --------------------------- <br /> ---•------------ ----- •-------•-------------- <br /> �` --------------------------------------------- --------------------------------- DATE--- -�- <br /> BUILDING PERMIT ISSUED------------- ----------------------------------- <br /> -------------------------------- ------------------- --------- ----------•--------- - DATE------- <br /> Alterations and/or recommendations------------ ----- ------ ". <br /> ----------------------------------------------- <br /> -- -------------- -------------------- <br /> ------------------------ -----------------------------------------------------------------------------------------------------------------I--------- -------------------- ------------------------------ <br /> -------------------------------------­­---------------------------------------------- ­------I----------- <br /> -----------------------------------------I----------I-------------------------------------------------------------------------I------ <br /> ------------- ---------- -------------------- ---------------------------------------------------------- ------------------------------------------ ------------------------------------------------------------------------ <br /> ----------I------------------------------ ------------------------------------------------ ------------------------------------- - <br /> ----------------------- <br /> ------------------------------ <br /> FINAL INSPECTION BY------------- <br /> - -- " _" <br /> --- -------------------------------. Date-. .----- -/- -�[-, <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT r r <br /> 130 South American Street 300 West Oak Street <br /> 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California <br /> Manteca, California Tracy, California <br /> '-2M io-sz Revised W-2100 <br />