Laserfiche WebLink
1 e/ <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) y� _ <br /> L � Date' Issued <br /> Application is hereby a�'e }o the San Joaquin Local Health District for aPpermit to construct and install the work herein described. <br /> This application is miadq irijcompliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATPN _----_ <br /> - <br /> Owner s Name----- - --��`---- -•!�---•- ��/ ------------------------------------ ----->-------------•------ <br /> Address <br /> -------------------------------- ---- ------- Phone--..-_. <br /> _ <br /> --------------A- <br /> -------- <br /> Name-----------4Z- <br /> Installation <br /> - <br /> will sery -_ <br /> -------------------- --------- ----- Phone_------ ------------------------ <br /> e: Residence U2�Apartment House ❑ Commercial <br /> ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: Number of bedrooms - - <br /> - Number of baths_,_1. Lot size - (� <br /> I Water Supply: Public system � --- ��-'------------------ '---- <br /> Y ❑- Community system ❑ Private ��epth to Water Table {t_ <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sand Loam <br /> Previous Application Made: Yes Na y " ❑ Clay Loam ❑ Clay ❑ Adobe�ardpan ❑ <br /> ❑ (� New Construction: Yes [] No R' FHA/VA: Yes ❑ No [�9 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: ' <br /> (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) y ~Y <br /> epti Tank: Distance from nearest weft--------- ------Distance from foundation.--- " # <br /> No. of compartments-'-� --•-- - ---------•--Material----=-------------- ------------'- ----------' <br /> Size Liquid depth- ------------------- Capacity_. ------- <br /> -------ispo al field: Distance from nearest well-_- _,Distance from foundation---_____- { <br /> ��Number of lines--------.--! f----------Distance_to nearest lot line <br /> •------------- -- - Length of each line_---__� <br /> Type of.filter material_ - --- -----------1Nidth of french----- �___-___-- __-_--. <br /> ;� De th of filter material__-�'��` ------_ <br /> ` p Total length . '° --------------------- <br /> Seepage Pit: Distance to- nearest w-11 --------------------- <br /> --- -'.Distance from m fou ation___- <br /> ��._-_-_.Distance to nearest low line__ , <br /> Number of pits.- :-`-___------Lining material—/ . - Size: Diameter- __-___ ,� <br /> Cesspool: Distance from nearest well ____ Depth_-.- -- --------- - <br /> _Distance from found---ion--------------------Lining material------------------------------ ------ <br /> ❑ Size: Diameter---�--------- ---------'- ----------Depth---------- ---- i <br /> ( --------------------Liquid Capacity-------------------- <br /> Privy: Distance from nearest well----------------------- 1 -gals. (� <br /> ___-___-___.Distance from nearest building 1 <br /> ❑ Distance to nearest lot line.-.- ' - _ - g -- ------' �•v <br /> Remodeling an ------------------------ <br /> d/or repairing (describe)---------------- <br /> ------------------------------ <br /> -------------------------------------------------------------••---•--------•------------------------------------- ----------------- <br /> ------ <br /> I hereby certify that I have prepared this application and:that the work will be lane in accordance with San Joaquin County <br /> ordinances, State laws, and ru es an&regulations of the San Joaquin Local Health District. <br /> (Signed)------------------- <br /> ---------------- <br /> ------•---- <br /> BY:---------------- t � Contractor <br /> ---------- .. <br /> -- -- -- � - -----? ------------------------(Title}-__---�nr. C <br /> tar <br /> - ' <br /> Plot plan, showing size of lot, locate f system in relation wells, buildings, etc., can-be placed on rever side). <br /> y <br /> (' FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY�'______ <br /> REVIEWED BY DATES'—---- <br /> --•----------------•-- -- <br /> ---------------------' DATE - ! <br /> BUILDING PERMIT ISSUED------------ ' ------------- - <br /> Alterations and/or recommendations--------------------------'- DATE-------Qee.-__ ; <br /> -----------1------t� <br /> i ------------------------------- <br /> k •---------------------- <br /> - <br /> ------------ <br /> FINAL INSPECTION' BY--- ---- ----------------------------------------- ! `� "" <br /> ------ <br /> ate <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American-Sfreet 300 West Oak Street, ti 132 Sycamore Sfreat �. <br /> Stockton, California Lodi, California "" Y „i 814 Norfh "C" Sfreef <br /> Manteca,California - �+ 'Tracy, California <br /> ES-9-2M Revised1 <br /> 1.57 F.P.CO. !� <br />