Laserfiche WebLink
A�Pro�� <br /> APPLICATION FOR SANITATION PERMIT Permit No. ._lo -�-_(Complete in Duplicate) <br /> Date Issued ___ <br /> Applica+ion is hereby 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 wit"bounty Ordinance No. 544. F-)Z1.4t -,v p ,���rps _ - �'� /f <br /> JOB ADDRESS ALLOCATION_ � f9 _ _ _ .1- �t /'r_• +_�41�R �.c � ; ----------.- <br /> Owner's Name---------- -------- .---•--------- '----------------------------------------------------- Phos tc,r�: <br /> �✓ !�` r <br /> - ---• oAddress--•------------------- --- Phn <br /> ------Y -- <br /> e <br /> -'--¢-••- - --��---- <br /> �- --------Contractor's Name----------------------- ------ <br /> Installation will serve: Residence [40'*`Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __, __ Number of bedrooms _ _ Number of baths /_.-_ Lot size -------242-`- -----2 `._____.._____ <br /> Water Supply: Public system ❑ Community system ❑ Private PTO"'Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand F Gravel ❑ Sandy Loam ❑, Clay Loam ❑ Clay ❑ Adobe 2---Hardpan ❑ <br /> Previous Application Made: Yes ❑ No New Construction: Yes 94No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) �� <br /> Septic nk: Distance from nearest w II_ _. _Distance from foun anon__1_0__A____.Materiall---4 -._-_-:� __S\_'___ i_____________ <br /> No. of compartments___i�a/..__- __...___Size 4lzr_:__ ____Liquid depth----,�i_ Capacity_ P. _�q¢r <br /> Disposal Id: Distance from nearest well-%�n_*�....Distance rom foundation...__.*......Distance to nearest lot line_________________ <br /> Number of lines------ __!______________Length of each line_- _.-__._. _____ Width of trench___ t_�` -______..__._________ <br /> Air R- # <br /> Type or filter material__I��_. � __-Depth of filter matenal____._� ------- Total length...__/_�!�_, _ ___________________ <br /> Seepage Pit: Distance to nearest well- --------------------Distance from foundation---------------------Distance to nearest lot line--.-------------- S: <br /> ❑ Number of pits----------------------Lining material-----------------------Size: Diameter.-----------.----------Depth--------_------------------------ <br /> Cesspool: Distance from nearest wail--------_--------Distance from foundation--------------------Lining material________--______________.__._________ lop. <br /> El Size: Diameter----- --- ----------------------------Depth_----------------------------------------- --------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well ________________----------_---------------------Distance from nearest building------..__.__-____________._______.____ <br /> ❑ Distance to nearest lot line-------- ------- -------------------------------•----------------------------------------------------------------------------- ------------- <br /> Remodelingand/or repairing (describe)------------------------------------------------------------------------------------------------­------------------------------------------------------ <br /> ---------------•----•--•-------------------------------•---------------------------------------------------------------------•---------------------------- -------------------------------------•--•------------------------ <br /> --- - ----------- --- ------------------ ---------------------- ----------------------------------------• ---------------..----------------------------------------------------------------------------------- <br /> I hereby�certi y that I heye prepared,Ft application and that the work will be done in accordance with San Joaquin County <br /> ordinances, fpJAaws, and les and re u. tions of the Sand oaquin Local Health District. <br /> - <br /> (Signed].-- f�� 1�1. ': n �u } „r{ ✓-- Contractor) <br /> �Y� A-_A= d ! ' '= ----------(Title __ '_ �-Yt ! -------------------- <br /> ----------------------------------•-- ----------- <br /> (Plot plan, showing size of lot, location of syste in relation to-wells, bu'� ings, etc., can bep aced on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY---- -------------- --- ---- ------------------ -- ---------------------------------------- DATE---- , ----------------------------------------------- <br /> REVIEWEDBY-------------------------------- ---------- ---------- ------------------ ---------------------------------- DATE-------------- <br /> BUILDING PERMIT ISSUED------------------------- - DATE----- ------- <br /> Alterations and/or recommendations:---------------- ----- _. <br /> -------------- <br /> -------------------- <br /> ----- ------- <br /> - ---- ----- ---------------------------------------- ----------------------------------- ----•- -------------------------- ----- <br /> -------•-- ----------------------------------------------------------------------------------------------------------------- ------------------------•---•-----------------•------..-..------- , ..._..._.- -------------- <br /> ------------------------------------------------------------------------------------------------------- ----------------•------------------------- ------------------------------------------------------------------------- <br /> ---------------•-------------- ---------------------------------------- - -------------------------------------- -----------------•---------------------I------ ----------------------------------------------------- <br /> FINALINSPECTION BY:...: ; -----------------•- --------------------- Date-•-------------------- -- --- ------------------------------------------------- <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 1 <br /> E5-9-2M 145446 ATWUnO 12-54 <br />