Laserfiche WebLink
APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) Date issued 5 0 5 r <br /> I <br /> Applica+ion is hereby made to the San Joaquin Local Health Distrio for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinan <br /> JOB ADDRESS AND TION--- - -- --- --- =---- <br /> ._ nP ----•------ ---------------------- <br /> S T <br /> Owner's Name- ----- ---- -- - --------- Phone----- I <br /> Address --- ---------- --------------- ----------------------------------------------------------------------------- <br /> Y/ -- -- ------ -- <br /> Contractor's Name--. Phone.-_ .../�� <br /> Installation will serve: Resi ence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ._ umber of bedrooms _-t!�Number of baths I_-_ Lot size <br /> 0--------------------- <br /> Water Supply: Public system E] Community system'❑"Privatej�( Depth to Water Tablas 1_ 9ffi_ <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe, Hardpan ❑ <br /> Previous Application Made: Yes I:] No� New Construction: Yes �� No El / <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: f ` <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic T nk: Distance from nearest well----------------- from foundation-------------------'Material-------------------_--_-------_--------..-_--. <br /> '0� No. of compartments--------------------------Size------------------------- •-•Liquid depth---------------------- ---Capacity------- <br /> Disposa'll Fri, kdl: Distance from nearest well-- -----------Distance from foundation--------------------Distance to nearest lot line.__----__--_---. <br /> ❑ Number of lines------------------------- Length of each line------------------------------Width of french----------------------------------- <br /> Type of filter material-_-.--_ 10A Depth of filter material-_--------------------Total length----_--.._-_---_---------.__---_----_-�-- <br /> Seepa e Pi : Distance to nearest we1!_x- RI--_---Distance f om fo ndation_-./a_-1--_--.Distance to neares .lat—li, e------ir <br /> L •� -..Size: Diameter -- - -------------Depth- <br /> Number <br /> - t <br /> Number of pits_...--/-------------Lining material__ p <br /> Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material----_._____---------._---__-----_--- \ <br /> ❑ Size: Diameter------------------ ------------------Depth---------------------------------- -----------------Liquid Capacity----------------------------gals. ., <br /> Privy: � <br /> ---Distance from nearest b0clin <br /> Distance prom nearest yell---------------------------- ------- - - 9------------------------------------------- <br /> ❑ Distance to nearest lot line--------.._ " <br /> Remodeling / p <br /> and or re a. in % <br /> describe,:--- s2l �---- - ------- � <br /> " `__ -- - ------ — – <br /> e _ - _--___----------------------------------------- <br /> ` <br /> ----------------------------------- ---------• -------------­----- ------------------------------------------- --------------------------------------------------------------------------------------------------------- — <br /> I hereby certify that have prepar'd this application and th the work will be done in accordance with San Joaquin County <br /> ordinances, State I ws,and rules and regulations of_he San Joaquin Local Health District. <br /> �----- --------- - ------------------------------------------------ = caner And/or.Contractor <br /> (Signed1-------------- -.------ r�.. <br /> r -- <br /> By:-------------- -------- ---------------------- ------------------------------------- ` <br /> ----=---------------- <br /> (Plat pian, showing s -------------------------------------------------------------- <br /> e of to+, loca+ion of system in relation to wells, buildings, etc., can be place on reverse ride). <br /> FOR DEPARTMENT USE ONLY ✓ <br /> DATE------- -- ------------------------------ i <br /> APPLICATION ACCEPTED BY-- ---` -------- ---- ---- ------------------------------------------------------------ �----------- --- a <br /> REVIEWED BY-------------------------- -------- ----- --- ------------------------------------------------------- <br /> DATE-------- -- -------------- •-------------------- <br /> t -BUILDING PERMIT ISSUED------------- -------------- DATE <br /> h - -------------- <br /> ------------------------- <br /> Alterat' n - or r commendations:---- --------- --- -- .3 ` .( <br /> s G' <br /> fid <br /> ------------------ <br /> :::::: :::::..:: _ _ _ =may::: Q :_ __ :::::--::: _ :::: ::::::::::::::::::::::::::::::::::::::::::_::::::::::: ------ <br /> ------------ <br /> --- ---- <br /> FINAL INSPECTION BY:-_----- - _�� --- ----- ----- Date <br /> ---- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT t r <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street ' y <br /> Stockton, Gelifarnia <br /> Lodi, California Manteca, California Tracy, California <br /> ES-9-2M . IRevised W-2100 <br />