Laserfiche WebLink
Document management portal powered by Laserfiche WebLink 9 © 1998-2015 Laserfiche. All rights reserved.
APPLICATION FOR SANITATION PERMIT Permit No. . <br /> --------- <br /> (Complete in Duplicate) 7 S <br /> ,s Date Issued /.._..�_ <br /> Application is hereby made to the San Joaquin Local H agth District for a permit to construct and install the work herein described. <br /> This application is made in compliance with O mance Nlo. 549. ?. <br /> JOB ADDRESS AND LOCATION............. - --------•-----•---------------------------------------------------------------- ---------------------- it <br /> Owners Nam. , y .= 1`� /( -----A-- - -- r' r r = hone �� � <br /> Address e'c e-E -- -------- ---------- -' `''f --- ---- - <br /> - .. <br /> Contractor's Name---------------- - F f :G ------------------------------------------------------- Phone... <br /> Installation will serve: Resi nce Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -1.---- umber of bedrooms ___/_ Number of baths -__� __ Lot size __________-____ <br /> Water Supply: Public system ❑ Community system ❑ Privatej� 'Depth to Water Table eft. <br /> Character of soil to a depth of 3 feet: and Gravel [] Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: Yes ❑ No New Construction: Yes [IN0�f <br /> TYPE.OF INSTALLATION AND SPECIFIC `TIONS: <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 /> :, o. of compartments------- ------------------Size------------------ -------------Liquid depth--------------------------Capacity--------------� /�/� <br /> Disposal F' ld: Distance from nearest well 4 'D --_Distance from foundation__���_f__..Distance to nearest lot line_-_;_,>.___._--- ` <br /> Number of lines___________________________ _:Length of each line___= - ------r__.Width of +ranch-.,_ -______-__.___________- <br /> i Type of filter mateFial._ _ _-__- c! Depth of filtermaterial_____ _ __ _Total length____f_�?�j�--___________________ <br /> Fj► ; <br /> Seep age 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_________F------Distance from foundation--------------------Lining material_______.___-__-__-__________-____. <br /> ❑ Size: Diameter------ ------------------------------Dept h----------------------------------------------------Liquid Capacity---------------------------gal <br /> Privy: Diisfance from,nearest well------------------------- ---------------------Distance from nearest building--------------- - - <br /> Distene to nee estTlot lines""`"""" <br /> Remodeling and/or repairing {describe):_._ y' _�----- --•------ -- r----- ----- =Y--- -• --- I <br /> ---------------- <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 , and r s d regulations t e San Joaquin Local Health District. <br /> (Signed) _-(Owner and/or ontractor) <br /> Tale �-�'' Z <br /> sy-- -------------- : •-�1 -- -------------------------------------------•-------------------------------------------E ) ------;: <br /> (Piot plan, showing s of lot, location of system in relation to wells, buildings, etc., can be p ed on reverse si�). ; <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY F -------------------------------------------------- <br /> ---------------------------------------------- DATE--------- r��--�------------i <br /> ------------------ <br /> REVIEWEDBY------------------------------------------------------- ---------------------------------------------- ----------------------- DATE------------------------------- <br /> BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE--:---------------------------------------------------------- <br /> Alterationsand/or recommendations--------------------------------------------------- -----------------------------------------------------------------------------------..._.---------------- <br /> --------------------------------------------•---------------------------------------------------------------------------- <br /> I1 <br /> ------------------------------------------•-•------------------------------------------- -- ------------- ------------------------------------------------------------------------------------------------------- <br /> -------- -------- --------------------- -------------`------------ ------------ -------------------------------------------------------------•------------------------------------------------------------------------------- <br /> 3 <br /> FIN AL INSPECTION BY: ---------------------------------- Date(?-_ + <br /> Y <br /> vi <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> VI <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street ata North "C" Street <br /> !' Stockton, California Lodi, California Manteca, California Tracy, California <br /> J <br /> I; <br /> ES--4-2M 10-52 Revised W-2100 <br /> 7 <br />