Laserfiche WebLink
APPLICATION FOR SANITATION PERMIT Permit No. _Q___, <br /> (Complete in Duplicate) l <br /> Date Issued __ ___ ( 5---_.- <br /> TA plica-%n 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. 49. <br /> JOB ADDRESS AND LOCATION----- - ��-� �� Gid' --------------------------- <br /> Owner's Name- - - ---••-•------ L" �� "' ----- - Phone------------------- <br /> f ----- -- - ------------ ----------- ---- <br /> e� � <br /> -------------------------------------- <br /> Address....... ------ ---- ---�ig -----•------ ----------- <br /> Contractors Name .. ---------------------------------• ----------------- Phone f�� d <br /> Installation will serve: Residence [ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _/.---- Number of bedrooms -_ 2-44Qmber of baths }-__._ Lot size ------ -------------------- <br /> Water Supply: Public system Rt_ Community system ❑ Private ❑ ,Depth to Water Table _&�,ft. <br /> Character of soil to a depth of 3 feet: Sand.❑ Gravel ❑ Sandy Loam E] Clay Loam E] Clay [3AdobeK Hardpan F]Previous Application Made: Yes E] No,RL New Construction: Yes Ok_No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: L. j <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) t <br /> Septic Tank: - istance from nearest well__,V stance from foundation__.-��__-_---.Material___± ._____r rc--r�_-. <br /> of compartments _Size___ _ (<rr__.Li uid de th_--- --------Ca acit 17. r <br /> p - q p. P Y <br /> Disposa�ield / <br /> istance from nearest weil__,1007.Q_Distance from foundation_ <br /> l9.J_....Distance to nearest lot line._-1� /... <br /> Number of lines-_________ _______ ,___._. _ ength of each line__. _ y_ Width of french_--_-_ _ <br /> � �cJ f <br /> Type of filter mater al-_ __ __ 5.f'CUepth of filter material____--_&---------Total length------ ------------------ <br /> Seepage Pit: Distance to nearest well___�f�. Distance fr fou da#io ___ Q____._.Distance to nearest lot line..___/� <br /> �- i �> <br /> Number of pits... ..............Lining material_._ zre - iameter____._.___ .. De th___..__ j <br /> Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material--------------------._-_----_-__-_-_- <br /> ❑ Size: Diameter------ ----------------------- ----Depth------- ----------------------------------- --------Liquid Capacity-_-----•------------------gals. \ <br /> Privy: Distance from nearest well-----------------------------------------------__Distance from nearest building---_.-_---.--__-___-_._____----.-.--.__-. <br /> ❑ Distance to nearest lot line-------------------------------------------- - ----------- ------•-------------------------------------------------------------- <br /> Remodeling and/or repairing (describe):-------------------------------------- ---------•-- ----------•-----------------------••--•----•--•-•-----•--------------------•----------------------- ' <br /> -------------•--------•--•---•-------------------------------------------------------------------------------------------------------------------------•-------------------------•--------••--------------------------- , <br /> ------------------------------------------ ---------•-----•-----•--------------;------------------------------------------------------------------------------------•-----•----------------------------------------------- <br /> I hereby certif I have prepared this application and that the work will be done in accordance with San Joaquin County 4 <br /> ordinances, Sta aws, d rules and regulations of the San Joaquin Local Health District. <br /> (Signed) --, -------� ---------- � -------------- ---------------------(Owner and/or Contractor) <br /> By:.-•- --- -------- - ------ ------ ---•-- ------ ----- z - -------------(Title)-------� t_-------------- ----- --------- t >� <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----- ---------•---------- ----- - --------------- • -------------------------------------- DAT - --------- <br /> BUiLDING.PERMIT ISSUED - <br /> --- DATE-------- ._.\ ------------•---------------------------- <br /> Alterationsand/or recomme dations------------- ----- --------------------------------•--------------------•-- • ------ -•-•--E>------------------------ --- <br /> ---------------------.-- <br /> .................... ---- ---- ----- - - ----------- "I"'--------------------------- ------- --------------­-­I--------I----------- <br /> ---------------- --------- -- --------------------------------------------------------------------------------i --------�_ `------------------------------------------------------------------------------------- <br /> ----------...... t------ -------------------------------- --- <br /> FINAL INSPECTION BY:.------ ------- ------------------------------- Date----- J- r--- --- ------------------------ <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 /> ES-9 745446 ATWOOD <br />