Laserfiche WebLink
APPLICATION FOR SANITATION PERMIT Permit No. __4;..�7-6�f <br /> ' (Complete in Duplicate) i <br /> Date Issued ---------- <br /> Applica{ion is ereby 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 t4g, 549. <br /> J08 ADDRESS AND <br /> -- LOC TION.!- ¢_�_�_�- .� ► J y`L--L -------­----------------------------1 "e- <br /> Owner's Name-----1 ]_ , 1 TJ <br /> Phone--------------------------- <br /> Address-----•�--�`�-----S'--••--C-- -c'-='-�'�--------------------------------------------------•-------------------------------------- <br /> Contractor's Name-----©�1----- ----- ----------------------------------------------------•-- ------------------ " <br /> Phone <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ ` Motel ❑ Other El <br /> Number of living units: __.1_--- Number of bedrooms_-" Number of baths ---I--- Lot size ---6_Y__X-.--�-- - ----------------_---_ <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Wafter Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑- .Clay Loam [❑ Cla.y ❑ Adobe& Hardpan ❑ <br /> Previous Application Made: Yes ❑ No$�N New Construction: Yes N0 ❑ <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_).V.O.h_?_Distance from foundation---1-_Ca----------Material-TZ-e,.j_(a3-._____•_ __------------- <br /> No. of compartments------ .--------.-- Size-- -X-S:-_ --`j-----Liquid depth.-._-_,�-----------------Capacity-.. -{3..- ----- <br /> Disposal Field: Distance from nearest well-_4.4-h-Distance from foundation_-1--42_...--------Distance to nearest lot line------ ------ <br /> Number of lines--------c]_'--. -------- Le fhof each line----�a--- __ -_._.Width of trench--- - - _-�..----_---_-. <br /> Type of filter materia <br /> - <br /> ,D f filter material----T --------------Total length---L-9i 0-__- •----------_-------- <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----.--.----_-__- <br /> ❑ Number of pits----------------------Lining material-----------------------Size: Diameter--------------._-..----.Depth--------------------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material-----------------.-__---------__--_- <br /> ❑ Size: Diameter------------- ---- -------------------Depth_--------------------------- - - - ------ --Liquid Capacity------------------ ---------gals. r/1 <br /> Privy: Distance from nearest well-----,_-----------------------------------------Distance from nearest building------------------------------------------ _ . <br /> �.. <br /> ❑ Distance to nearest lot line --- ------------------------------------ <br /> L <br /> --------------------------------- --•------------------•-----------------•----------------------- ----------------------- -- � <br /> Remodeling and/or repairing (describe):---- ------ -------•---------- •--•-----• D_ <br /> --••-------------------•------------------------••--•--•--•--------------------•------------••-•--------------------•----------------•-••-------------...-----------------••------•-----------•-...--------------------------- <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 r la ions ntle SarrJoaquin Local Health District." <br /> (Signed) Y&�L--- - /-------- =----- --- --- --- - ------(Owner and/or Contractor) <br /> By:-------------------------------------------------------------------- --------------------- - --------------------(Title)------------ --- <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------------ -------- ---- ------------------------------------- •--------------------------- DATE---------------------------- <br /> REVIEWED BY-------------------------------------- - --- �` DATE <br /> - -------- --------- --------- ------- <br /> IN"—---•-------------- -------------- <br /> BUILDING PERMIT ISSUED----------------- ----- ------ --- ---------------------------------------------------------------- DATE-- -- -----CSS <br /> Alterations and/or recommendations:. - - ------------------------------------•-------------•-------- ------------------ ------•------------ <br /> ---------------------- ----------------------------------------------.....-------------------------------- ----------------------------------------------------- .....---------------- --- ------------------ <br /> ---------- -------------------------••--------------------------------------------- -------------------------------------------------- ----•---------------------------------------•------------------------•-•------------ <br /> ------------------------------------ ------- ------------------------------------------- - --------- ------------------------------------------------•-------------------------------------------------------------- <br /> FINAL INSPECTION BY:----- ------- �------------ ---•---------------- Date.- .-.- ----------------- <br /> -- --`--- ---- ___�------------- <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 /> � k <br /> ES--9-^2M 145446 ATW000 12-54 <br />