Laserfiche WebLink
l­UK Ul-FICE USE: <br /> -------------- -- ----------- --------------------------- APPLICATION FOR SANITATION PERMIT Permit No. <br /> --- ------------- ------ ----- - ---------- ---------- (Complete in Duplicate) <br /> --- ---------- -- ---- ------- ­---------- --- ... This Permit ExfresI Year From Date Issued -7 <br /> Date issued z__ <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 AD LOCATION------- ?------- <br /> Owner's Name____ ---------- - --------- ------ ------------- ----------- ----------- ------------ ----- -- Phone----- <br /> Address-------- <br /> -------------------- ------------------- ------------------------------------------------------------------ ---------------------- <br /> Contractor's Name_-____________________---- <br /> ----------------- <br /> Installation will serve: Residence �Apartment House ❑ Commercial El Trailer Court <br /> El Motel [3 Other El <br /> Number of living units. N,' <br /> mber of bedrooms Number of baths _L& size --- <br /> Water Supply: Public system Community system El Private F] Depth to Water Table 17�' ft. <br /> Character of soil to a depth of 3 feet: . Sand E] Gravel ❑ Sandy Loam E] Clay Loam E] Clay El Adobe E- Hardpan <br /> ❑ <br /> Previous Application Mad (If yes,date.__-_____.-_._--.__} No M---'New Construction: Yes El No.�HA/VA. Yes F1 No El <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 20046e*.) <br /> qaplTanl: Distance from nearest well---______-___.__Distance from foundation__________ _________Material___-_.-_-_____--.-___- <br /> f -- ---- ------------------ ------------ ---------- <br /> No. ocompartments Size ..Liqu;d depth--------------------------Capacify--------------'jr <br /> Disposal <br /> � I -- <br /> Id: Distance from nearest weltzex&Distance from foundation---/�- ---------Distance to nearest lot line,--,, <br /> Number of lines__----Z -----------Length of each 1i4e------------- Width of trench---- <br /> 0 <br /> Type T filter ma'ferial. --Depth of filter maferi'aI___,o2jV. .......Total length--------- <br /> -------- ---------------------- <br /> el (Ir" <br /> Seepage Distance to nearest weII7?��-----Distance from founclation_.Xe_.___-_Distance to nearest lot line....!;�7 <br /> Number of pits.-!--/ <br /> ------ Size: Diameter.—Ra------------Depfh------_-2 <br /> ----SS-------------- <br /> Cesspool: Distance from nearest well________________--Distance from foundation- --- ---------Lining material---____-______----_-___--_.__-- <br /> F1 Size; Diameter----- ------- ------- ----------------Depth------------- ----------------------Liquid Capacity ---- -gals <br /> --- <br /> Privy: Distance from nearest well__________________ - <br /> - _____--_____Distance from nearest builcling-----------------------------------------�1310 <br /> El Distance to nearest lot line_______________ ------------------ ------------------------------------------------ <br /> Remodeling and/or repairing (describe)_________________________ <br /> ------------------------------------------------------- <br /> _P <br /> --------------- ----------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------- --------------------- <br /> --------------------------------------------------------- <br /> ----------------------,-------------------------------------------------------------------------------------------------------------------------------- <br /> ---------------------- ------------- -----------------I--------I <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, State laws, and rules Van regulations of f e San Joaquin Local Health District. <br /> (Signed)- ------------- ....... .. <br /> ------ --- ---- --- - ------ ---------- ----- ------------------ <br /> ;152----( net and/or Contractor) <br /> Z70 ---------- - --- -- ---------------- - <br /> By:----------------------------------------------I— <br /> (Plot plan, showing size of lot, location of-Xsysfem in- ------tio-_ -- -------- ----- --- <br /> rela n to Its, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---- ... --------------------------- DATE <br /> ---------- --------/ <br /> DATE <br /> REVIEWED BY ....... ------- --------------- <br /> ----------- ---------------- -------------------------------------------- ------------------------------------- <br /> BUILDING PERMIT ISSUED------------------ E <br /> ------------------------------ <br /> ----------------------------------------------------- <br /> Alterations and/or recommendaf ions:-- <br /> ------------------------------------ ------------_------------------------------- --------------------- ------------------------------------------ -------------- ----------------------L------------------------------ <br /> ------------------------------------------------------------------------------ ----------------------- --------------------------------------­---------------- --------------------------- ------------------------------- <br /> ------------- ------------------- ----------- ---------------- --------------- --------------------- -------------------- ............ --------------------- ---------------------------------------------------- <br /> --------------- ----- --------------- --------------------------------- --------------------- --------------------------- ------------------------------------- ---------------------------- <br /> FINAL INSPECTION BY:_--_--- ----- -------- -------------------- Date_----- <br /> ------------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West Stir Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br />