Laserfiche WebLink
APPLICATION FOR SANITATION PERMIT Permit No.,`_-----___----- <br /> (Complete in Duplicate) <br /> Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein de cribed. <br /> This application is made in compliance with /C/ounty Ordinance No. 549. <br /> JOB ADDRESS AND-POCATION ----` �,(7 °�------A4--'---- � ..�' - ------------------------- ---- ------------------------------------------------ <br /> Owner's Name--------- A_-� t' �l 0L4--5:a 1-SCJ--------- -------------------------------------- phone----------------------------- <br /> Address---------------`r`/oZ °...... a <br /> � ---------------------------------------------------------------------------------------------------------------------------------------- <br /> Contractor's Name--------- r----------------•-----•---------------•-------•-----•--------•---------------------------- Phone------------------- <br /> Installation will serve: Residence (A-"Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _/--- Number of b6drooms ---`6--. Number of baths I____ Lot size --_ --------__________________ <br /> Wafer Supply: Public system R­--Communify system ❑ Private ❑ Depth to Water Table y�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 B--'No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material--______________________________________________ <br /> kx1Z1/Ir I No. of compartments------------- -----Size---•--------------------------Liquid depth,-------------------------Capacity....................... j` , <br /> r <br /> Disposal Field: Distance from nearest well-----------------Distance from foundation------------------_Distance to nearest lot line----------------- <br /> kX 7`1/11 Number of lines-----------------------------------Length of each line------------------------------Width of trench----------------------------------- Q <br /> Type of filter material-------------------------Depth of filter material---.-------------------Total length-------.---------------------------------- <br /> Seepage Pit: Distance to nearest well--"AJY.E----Distance from found .ation- `/r A.i-..___.Distance to nearest lot line_____` <br /> , <br /> Number of pits----- -- -- <br /> -------------Lining material-- -_°_8 Size: Diameter------3.re I,----------Dept n------ <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 /> ElDistance to nearest lot line-------- ---------- ------------------------------------------------------------------------------------------------------------------------- <br /> Remodeling and/or repairing (describe)-------------------------------------------------------------------------------------------------- •-----•-------------------------------------------- <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 and regulations of the San Joaquin Local Health District. <br /> ���O 00e _-__-__.Owner and/or(Signed)------...--�------- -- �; --- ( / Contractor) <br /> Scr -e-S ,-"--e- �f) <br /> (Plot plan, showing size of lot, location of stem in relation to wells, buildings, efc., can be placed,on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY �� -------------------------- DATE--------- 5� � - S- <br /> REVIEWEDBY----------------------------- - ------ ------------------------ DATE---------------- <br /> BUILDING PERMIT ISSUED-------------------------------------------------------------------- --------------------------- DATE--------------------- <br /> Alterations and/or recommendations:------------------------------------ -----------------•---•----------------------------------•-•-----••---....-------•-------------•----------•-------------- <br /> -----------------------------------------------------------•---------------------------------------•------------------------------------------------------------------- ------------------------------------------------•--- <br /> -----------------------------------------------------------------•--•---------- ------------- <br /> FINAL INSPECTION BY: (/ ---------------- Date---- ---------------------------- --------- --------------- <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-2140 <br />