Laserfiche WebLink
14 APPLICATION FOR SANITATION PERMIT ,Permit ?.5.�-.______ <br /> (Complete in Duplicate) " <br /> Date Issued <br /> Applica"ion 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. 5 <br /> �% <br /> JOB ADDRESS AND LOCATI -N..---------e. ----- ----- ---- 4--- .<--i����' ----------- <br /> Owner's <br /> -------- f - <br /> Owners Name-----------� ��' .� - ----- ._- -------- ----- <br /> I_.___�- x�-�,��-----:. „=- -�-�.�_..-�--;------ -- - --- ---------- - --- _ Phone----...----._.---------------.._---- <br /> Address--------------------- <br /> ------------ --• , –r r------------ <br /> Contractor's Name__J C1 __*7....•. - - -- -------- -- --/ if /t----- ------ Phone. <br /> Installation will serve: Residence ❑ Apa•rt ` nt House ❑ Commercial Trailer Court ❑ Motel 0 Other ❑ <br /> Number of living units: _...____ Nu er of bedrooms ________ Number of baths _______ Lot size � _ ______ ,�/__ �_____._______ <br /> , <br /> Water Supply: Public system Community sysiem ❑ Private ❑ Depth to Water Table ________ ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available wifhin 200 feet.) <br /> Septic Tan - Distance from nearest well-----------------Distance from foundation--------------------Material_______,_-_---_.-_________________-_....___-____. <br /> No. of compartments---------------------------Size--------------------------------Liquid depth----------------------....Capacity...•------------------- <br /> Disposal Fi Distance from nearest well--------4'---..._Distance from foundation___-__________._.Distance to nearest lot line_____________-- <br /> Number of lines------------------------------"---Length of each line-.------.---------------------Width of trench----------------------------------- <br /> Type of filter material---------------- -------Depth of filter material__________________r._Total length------------------------------------------ <br /> Seepage <br /> __.____.___________________________-__-_Seepage Pit: Distance fo neare t well-J--.-?d-------Distance from 9ndafion. <br /> f�Qn___ 41;�..____.Disfanr_9 to nearest Iodine_-- ` � <br /> „ � or --- <br /> Number of pits. /L.------_-_Lining material rte'.: Diameter__...---Depth------______�t________________ <br /> � 1 <br /> --------------- <br /> Cesspool: Distance from nearest well-------:--------Distance�om ------------------ Lining material-------------------.----------------- , n <br /> 171 Size. Diameter--------------------- ----------------Dept h----------------------------------------------------Liquid Capacity- ----------------------------gals. A f <br /> Privy: Distance from nearest well-------_-----------------------------------------Distance from nearest building_-------_____________--_________.____..__. S <br /> ❑ Distance to nearest lot line------ - -- - - ------------------------------------- - ---------- <br /> .� <br /> Remodeling and/or repairing (descriUej: F..------------------•-•-- S. <br /> e ,- <br /> -- -------------- <br /> ------------------------ <br /> ------------------------------ ---------------------­---1-------- --------------------------------- ----- ­ ------------------------------- ------------------------------------- <br /> Dr] .14 onein accordance with San Joaquin County <br /> I <br /> -•------------ ----•---•--- <br /> I hereby certify that I have prepared this application and that the wor will be done,in accordance with San Joaquin County <br /> ordinances, State la and rules and ulat' ns of the S n Joaquin Lac alth District. <br /> i <br /> Si ned Q _'- _. �G_. _--- ��C ,p O er and 'r Contractor <br /> �Y� _� - t _---------------------Via--_. --------------- -- -- -(Title)---- <br /> --------11------------------------ <br /> (Plot plan, showing size of ot, 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 /> REVIEWEDBY---------------------------------------------"-- ----------- --------•- --------=----------------------------- DATE------------ <br /> ------ <br /> PERMITISSUED------------------------------------ -- ------------------------------------------------------------- DATE-----------•-- <br /> --- <br /> Alterations and/or recommendations: . - _.. -• ---------------•------------------------------ -------------------------------------Ay. <br /> ------------------------•-----------------------------•---------------------------•--------------------------------------------------------•----------------------• ------ ------------•----------------------------------•--- <br /> -------------------------------------------------------------------------------------------------------------------------•---•---------------------- ------------------------------------------------------------------------- <br /> FINAL INSPECTION ML._. _-­--------------------------------- Date-------- •------- �7 ----- ' <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-9-2M Revised W-2100 <br />