Laserfiche WebLink
APPLICATION FOR SANITATION PERMIT <br /> (Complete in Duplicate) <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 AND LOCATION-------------- ---- -- --------- =-------------- ------------------ - -------- ---------------- <br /> Owner's Name------------- -------- --.------ _---------------------------------------------------- Phone----------------------------------- <br /> Address------------------------- --- - =-------------------------------- ------------------------------------------------------------------------------------------------------------ <br /> Contractor's Name---------- -- --- �: } --------------- -------------------------•-•---------- Phone <br /> Installation will serve: Residence Apartment House Aommercial ❑ Trailer Court ❑ Motel J] Other ❑ <br /> t <br /> Number of living units: [b Nu er of bedrooms [i] Number of baths MLot size---,. ____ ,__1_------------______,<__�_______ <br /> Water Supply: Public sysfem EW Community system ❑ Private ❑ <br /> Character of soil to a depth of 3 feet: Sand ❑= Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: W <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Se tic Tank: Distance from nearest well--------------- Distance from foundation----4-6----------Material------ <br /> No. of compartments____________�---Capacity -------Size---- �------Liquid depth -------------- <br /> o <br /> Ces❑spooDistan'�e from st m - � # <br /> Size: Diameter--------------------------------------Depth----------------------------------------------------- <br /> .Privy: Distance from nearest well--------------------------------------------_----Distance from nearest building__________-_.____--______________________- ' <br /> ❑ Distance to nearest lot line________________________________________________ ' <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line____-___________. <br /> ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------.Depth------------r________------_ <br /> iDisposal Field: Distance from nearest well_____"____-Distance from foundation___/_�__ -________Distance to nearest lot-line.. %____.____ <br /> Number of lines--------------- - -----------------Length of each line-----------b_-D i -----Width of french------- - � ----------- <br /> De Depth bf filter material____f __:___ <br /> Type of filter material----7-kr—&-t-: p <br /> Remodeling and/or repairing (describe)-------------- <br /> ----------------- <br /> -------------•-------- -- --- �( --------------------------- <br /> _ _ y_ <br /> •__ -__•_- ----_ ---------_ _••___ - -- -_-. - - - -_ ---TJX- ----' - ___1 -- ----'---•--- -•_-----.-------.�-----•----- n <br /> - YYY <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 and regulations of-fhe San Joaquin Local Health District. <br /> 5i nedJ ./-------- ------(Owner and/or Contractor) <br /> By:--------------------------------------------------e ------=---------------------------------------------------------------------(Title)--------------------'`--------------------- <br /> --------------------- <br /> (Plot plans, showing size of lot, location of sysfem in relation to wells, buildings, etc., must be filed with this application). <br /> FOR DEPARTMENT USE ONLY <br /> 1 <br /> APPLICATION ACCEPTED BY---------- ; - ------- --------------------------------------- DATE---------- (�' ------- <br /> REVIEWED <br /> ------ <br /> REVIEWED BY----------------------------------------------------------------------------------------------------------------------------- DATE----------------------------- <br /> ---------------------------- <br /> BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE---------------------------- <br /> - ---- ----------- <br /> Alterations and/or recommendations--------------------------------------------------------------------------------•---------------------- •-------•--------------------------------------- <br /> -------------------------•-----••--•--------------------------.-- -----------------I--------------------------------------------------------------------------------------------------------•--•- <br /> PERMIT No.C/__f-�------- ISSUED------ -- _- __5 --- <br /> ----(Date) FINAL INSPECTION BY:----------v--------t--U. ? --------------------- <br /> Date-----------------------------r-�'L3-15-7----------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> ES-9-2M 9-50 W-1639 <br />