Laserfiche WebLink
APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) <br /> Date Issued ----- ./�f ' <br /> U <br /> A <br /> �plica4ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This <br /> application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND &j 5 if- )1e,k <br /> CATION....-- 22-53-1--------------- ---- ---- -- -- -------------------------------------------------------------------------------------------- <br /> ------------- ---------------- ----------------- --------------------------- Phone------------------------------------ <br /> Owner's Name------ ------ <br /> _j-----------(5........ <br /> Address............0�?_ L'�- <br /> - - --------------- *,*,*.........................................................................*---------------- <br /> Contractor's Name.-•--•-- lee_�t------1-,/'/c---------------------- ------------------------------ ---------------- Phone----------------------------------- <br /> Installation will serve: Residence T Apartment House [] Commercial E-] Trailer Court [-] Motel Ej Other Ej <br /> Number of living units: _/-_--- Number of bedrooms _S--- Number of baths ---/-- Lot size ----- ^X..../.P0---------------------------- <br /> Water Supply: Public system 1p Community system E] Private F1 Depth to Water Table 511--- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel El Sandy Loam E] Clay Loam 0 Clay 0 Adobe Hardpan ❑ <br /> Previous Application Made: iYes E-] No [� New Construction: Yes [j No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> 1! .! - 0 - -V <br /> Septic TaR70, from nearest well________________Distance from foundation------------------- <br /> of compartments--------------------------Size--------------------------------Liquid depth--------------- --------Capacity------ --- ------------ ' <br /> Di5posa <br /> Capacity----------------------- <br /> D;5posaI c e from nearest well__... --- Distance from foundation---------------_'.Distance to nearest lot line---------_----- <br /> El Nu ber of lines-----------------------------------Length of each line------------------------------Width of trench----------------------------------- <br /> r <br /> Type OT filter material-------- ------ ---------Depth of filter material-------------- --------Total length----------------------------------------- <br /> Seepage Pit: Disfancejo nearest well--- ------- <br /> --- --------Distance from fourL_dation__­�-- <br /> - -----Distance to nearest lot line---- ....... <br /> G9 Number of pits___ ___1 ____ - Lining material--C __AA,-. 3ke- Diamefer._­3__//--------Dept h...... -.2..- ----------------- <br /> Cesspool: Distance4rom nearest well-----------------Distance from foundation--------------------Lining material------------------------------------ <br /> ElSize: Diameter_—.----------------- ------ -------Depth-------------- -------------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Disfance-from nearest well----------------------------_.-.---_--------.----Distance from nearest building___-.-..-.-..---._--_-------------_----- �� <br /> ❑ <br /> uilding------------------------------------------ <br /> ElDistance'to nearest lot fire_._------------------------------------------------------------------------------------------------ ----------------------------------------- <br /> Remodelingand/or repairing (de5cribe):------------------------------------------------------------------------------------------------------------------ ---•-----....._I----------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------I- <br /> ----------------------- <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, Stat s, and 'rules and regulations of the San Joaquin Local Health District. <br /> (Signed).........../------ -- --------------------- -------------- ----------------------------------------------------------------------(Owner and/or Contractor) <br /> eAZE-, _ --- ------------------------------------------------(Title)--------- - ------------------------------ <br /> ---- <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 <br /> -BY - ------- - C ..--- <br /> 5 --- --- -------- ----- DATE <br /> REVIEWED BY---------------------------------- -- ------ ------------------- -------------- --------------------------------- <br /> --------------------------------- DATE---- ----------->-----------------­------ <br /> BUILDING PERMIT ISSUED---------------------------- -----7--- ------------------------------------------------------------- DATE.------------------ -------\_--- ------------------- --------------- <br /> Alterations and/or recommendations:-------------- -------------- -------------------------------------------------------------------- ----' ------ ---------------­,­------- <br /> ------------------------__------------- ----------------------------- 7. ....11Q-------- _­---­------------------------- -------------------------------------------- --------- --- -------------------------- <br /> A <br /> -------------------------------------------------- -------------- ------------- --- -------------------------- ---------I---------------------I---------- ----------------------------------------------------- <br /> --------------------------------------- ----------------------------------------------------------------------------------------------- ----------- ------------------------------------------ -----------1­--------------- <br /> -­-------------- ------------- ---------- ---------------------- ------------------------ ------- -----•---- - ------- ----------------------------- -------------------------------- <br /> FINAL INSPECTION BY: ------- <br /> ----------------------------- ... ... ........ ----------------------------- <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 /> FS-9-21Y 145446 ATWOU" 12-54, <br />