Laserfiche WebLink
Permit No. <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete in Duplicate) <br /> Date Issued <br /> Application is hereby made to the San Joaquin Local kd-ealth District for a permit to construct and install the work herein described. <br /> pp p y O"r� No, . <br /> This application is made in compliance with Cou t ina ce <br /> 549. <br /> P <br /> 4LAS --------------I-------------------------- --------- <br /> JOB ADDRESS &K1D CA --- -------------------- <br /> Owner's Na e_ _ Phone_e?,4_ __ -..-- <br /> Address - --- ---- ----- -------- <br /> --- ------ -- <br /> Contractor's Name - ------------------------------------------------- ------------------------------------ Phone----------------------------------- <br /> Installation will serve: Residence:) [ Apartment House [:] Commercial [ITrailerCourt I-] Motyl F] Other <br /> Number of living units: ___f___ Number of bedrooms -Z'- Number <br /> E] f baths _1___- Lot size _��___-__)-JCFO------------------- <br /> Water Supply: Public system. Community system ❑ Private Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand Gravel E] Sandy Lo/No <br /> Clay Loam E] Clay E] Adobe E] Hardpan E]Previous Application Made: Yes ❑ No New Construction: Yes ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 204 feet. / <br /> Septic nk: Distance from nearest well_L �_ __Distan fr i 101-VIanon____:_ Mate i I____._- ___ <br /> r� ,f <br /> No. of compartments_,______________ Size ��-�- _____Liquid eipth______--- ----Capacity...- - --__ <br /> t <br /> Dispospl Field: Distance from nearest well_ -_____Distance from foundation___:__ ------------Distance to nearest lot Iiirt__-___---_ <br /> Number of lines_________ __ ____ ___________:_Length of each line___________:'__ �______Wldth of trench-___/C.t__ _ <br /> J - , ---------- ---- <br /> Type of filter materia6 _ ''Ci Depth of filter mai-enal________r_�_-_______Total length--------- -_�_____________�____t___-- . <br /> Seeps e Pit: Distance to nearest w II _ �_,0________Distance from foundation_____1_l�_--Di to mo nearest lot line__ ------_-- <br /> Number of pits---------- ---------Lining material-----------------------Size: Diameter------ -T------.Depth---------- - -------------- <br /> Cesspool: Distance from nearest well_________________Distance from foundation----------- -------.Lining material---------------------------------------- <br /> 171 <br /> _-__ _________________________-____--❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well - - <br /> -=------------------------- --------------------Distance.from nearest building------------------------------------------- <br /> 0 Distance to nearest lot line-----------------------------------•----------------------------------------------------------------,----------------------------------------- <br /> Remodelingand/or-repairing (describe)--------------------------------------------------------------------------------------------------------------------•-•----------------------------- <br /> 4 <br /> ______________________________________________________________________________________________________________________________________________________________________________________________________________________ <br /> f <br /> I hereby certify that LWave prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances,r$fafe lawsj, anderule's land regulations of the San Joaquin Local Health District. <br /> V?ipo <br /> ----------- --- --------------------------------------------------------------- --------------------------------•-----------(Owner and/or Contractor) <br /> (Signed)-=-- ----0------ • - <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----L" - - --------------------------------------------------------------------------- DATE--e=�� - - ------- -------- +� <br /> DATE------------ .- - ---------------------- <br /> BUILDINGPERMIT ISSUED----------------- ----------------- ------------------------------------------------------- DATE------------------1 ----------------------------------- <br /> Alterationsand/or recommendations:------------------------------------------- ------------------------------------------------ ----------------•----------------------•-----------•---•---------- <br /> ----------- ----------------------------I-------------------------------------------------------I-------------------------------------------------------------------------------------------------------------- <br /> -------------------------------------------------------•---------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ----------------- ----•----------------------------------------------I---- <br /> FINAL INSPECTION BY:_ -------- Date-----A--'3----47X------------------------------------------ <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 /> I ES-9-2M 8-51 Revised W-2100 <br />