Laserfiche WebLink
APPLICATION FOR SANITATIPERMIT Permit No. <br /> T'l1�(Complete in Duplicave, <br /> q / <br /> ti 1P Date Issue III <br /> Applicaa-ion is hereby made to the San Joaquin Local Health District fora"p`e;�mit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> �C)14(& S - el�64Es-7—r21! <br /> JOB ADDRESS AND LOCATION.. ----------------- ---- ------- <br /> d,&, 6yL �I�-C.C�. R—..�. � C g'3- 2 �i�i—C� <br /> --- - <br /> Owner's Name-------------------=--- - --------------- - "------------ ------------ ------------------------------ Phone------ ----------------------------- <br /> Address---------------------- -------------- <br /> ---------------------------I----- ------------------------------------------------------------------------ e - <br /> Contractor's Name ! -------- ------------------------------ ------------------- -------------------------------- ------ Phone----------------------------------- <br /> Installation will serve:# Residences Apartment House E] Commercial ❑ Trailer Court p Motel E] Other F]Number of livinitNbf,bdLot size --- ----- <br /> g units: _..�_. Number oerooms __�}- Number of baths _l <br /> 1 It -- -. --�-=--��-�-r---�----��---------------- <br /> Water Supply: Public system ❑ Community system ❑ Privateo Depth to)Water Table _ ft. <br /> Character of soil to a depth of 3 feet: Sand,QGravel Ej Sandy Loam E]f I Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: Yes I] No New Construction: Yes fNo El <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well__5.7L)_____Distance from foundation______ _ _______Material_____________.__. <br /> No. of compartments.-------;___S- --.-----Size-----2—c_-_!�X__6_Q_r_Liquid depth--------_J�. K------Capa qty_________-- <br /> Dispos I Field: Distance from nearest we .... Distance from foundation_____1Q______.Distance to nearest lot line_______.___. <br /> Number of lines_______________ ___________Length bf each line-----------_�"�__�0--------.Width of french___-__----- <br /> Type of filter material,_ "`-'___Depth �f filter material_____48_________._Total length________________l�-o______________ <br /> Seepage Pit: Distance to near sof w�ll _�___-_--.`�__Distance from foundation-------------------.Distance to nearest lot line_---._-__________ <br /> ❑ Number of pits----------------------Lining material--------c___.---------Size: Diameter-----------------------Depth-----.--------------------------- (Q <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 <br /> --- --------- ------------------------Remodeling and/or repairing (describe):-----------------------------------------4---------------------------------------------------- -------------------------------------------------- <br /> ------------------ -------------------------------------------------------------------------------- <br /> �f <br /> --------------------------- ----------------------------------------------------------•------------------------------------------------------------------------------------------------•---------------------------------- <br /> --------------------------- --------'------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinanceVSfatawsand rules and yegulations of the San Joaquin. Local Health District. <br /> 4 <br /> (Signed) c f A (Owner and/or Contractor) <br /> By <br /> (Plot <br /> pla , showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> f FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---------------- <br /> -- ---- ---------------------------------------------------------------- DATE--------- <br /> �. <br /> REVIEWED BY------ -------------- - s---- - ---- DATE----------------- .. <br /> BUILDINGPERMIT ISSUED---------------------- ----------------­i------------_---------------------------------------- DATE------------------------------- <br /> Alterations and/or recommendations_____------------------------------------------------_______ <br /> -------- ------- <br /> _ <br /> -- . ------ <br /> ----------------------------------------------------------------------------- ---------- --------------------- ---- ------- <br /> ------ ----- <br /> -- -- ----- <br /> . --- <br /> 4 � <br /> ----------------------------------------I------ - - ------ ------ ----------- ---------------------------------------------- <br /> -2- <br /> -------- <br /> FINAL INSPECTION BY:------ - - Date Z. ------------------- <br /> SAN JOAQUIN LOCAs. HEALTH DISTRICT <br /> 130 South American Street 300 Wast Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M Revised W-2100 <br />