Laserfiche WebLink
,l . <br /> kr <br /> APPLICATION 'FOR SANITATION PERMIT <br /> Permit No. - -�" <br /> li <br /> D <br /> i <br /> l <br /> (Compete n Duplicate) Xw <br /> " 1 �• Date Issued ____________ _ <br /> Application is he'reby 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 Ordi ance No. 549. <br /> -- ------- ------------------------------------------------------- <br /> OBJADDRESS f�f1 D CAT N -- - -� --- -- ----- <br /> ,,.� ----- Phone ,► <br /> Address <br /> wner s am <br /> M <br /> ----.- Phone-------- <br /> .__. <br /> Contractor s Name--- . <br /> ' Installation will serve: Residence Apartment House ❑ jCommercial ❑ Trailer Court ❑ Motels ❑ Other ❑ <br /> Number of living units: :- umber of bedrooms Number of baths . ! <br /> Lot size _.t <br /> Water Supply: Public"`system [Community system El. Private ❑ Depth to Water Table __.:____ ft.�" <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ' Clay Loam E] Clay El Adobe�ardpan ❑ <br /> Previous Application Made: Yes ❑ No VNew Construction: Yes No El <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted ' ublic sewer is available within 200 feetr) <br /> Septic Tank: Distance from nearest well_..e--.- istan- from ound n _`____ ___.�No. of compartments------ -- iz __"'_X_1 _�e Liquid depth'_.___ -------------Capacity..-�-. <br /> 1.4 <br /> Dispos (Field: Distance from neare4well..-P-7-440Distance' from foundation!-11_ i'stance to nearest lot line � -.-------Number of lines___._[_. Length of each line_.---___..__ _ � _...Width of trench._____-_-- -.___Type of filter matef i epth of filter material- Total length ------ ---- f}` <br /> Seepage Pit: Distance to nearest well - .---Distance from foundation_ .._ .___D _a,nc to nearest lot Ime_____�___-____- <br /> Number of pits-__._-,1-.____-_-_ Lining material_-��_ �� Size: Diameter.___ _ -____-__Depth-----.777 '� <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 /> i Remq4lering and/or repair ng (describe :___ s._ --•----- <br /> t •--;- --- ' -- ----'- -------­------- ------------------------------------- <br /> - ------ ---- -- <br /> `` , L------------------------------------------------------------------------<-- ------------------------------------ <br /> ---------- ---- - --- ---- <br /> V 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 and regulations of the San Joaquin Local Health District. <br /> -------------------(Owner and/or Contract <br /> or) <br /> -------------- <br /> (Signe ----------- - ------------------------- <br /> B --------------------------------------------------------------------------------------------------------------------- ----(T'tle------------ <br /> y <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.. -_ DAT E----------------------------------------------------- <br /> DATE <br /> _______________ _____ _____.. ___-.._-_- _-- <br /> REVIEWED BY DATE-- "' ------------ <br /> ----------------- <br /> BUILDING PERMIT ISSUED-------------------------- n" -------------------- DATE........ 1/ <br /> Alterations and/or recommendations:--- ------------------------ ---- ----- - ------ ------ --- -------- ----- - ------- -------- ----- <br /> f ------------ ----------------•------------- ------------------ <br /> ------------- <br /> u a j ______________________________________-----------------------------_------- <br /> ----------- <br /> ________________________________________________________________________________________________________________________________________------------------------------------------------ . <br /> ---------------------------------------- <br /> ________________________________________________________________________________.___. <br /> FINAL INSPECTION 'BY__________________ _________ � <br /> - -------------- Date------------------------------- ---------- ------ ------------------------•---- <br /> t <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 0-52 Revised W-2100 <br />