Laserfiche WebLink
APPLICATION FOR SANITATION PERMIT Permit <br /> (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 with County Ordinance No, 549, <br /> 14 IV IV, <br /> JOB ADDRESS AND LOCATION--- -- ------------------------------ ------- <br /> Owner's Name-------AI w.r.---------------- --------------- -------------------------------- -------- Phone------------------------------------ <br /> Address --------A, Y4 <br /> -------------------- ------------------------------------------------------------------------------------------------------------- <br /> Contractor's Name------ Z-,4;444 �---------� 5­0-N­�:-----------------­- --------------------------------------------- Phone- <br /> pc_4 <br /> Installation will serve; Residence PL Apartment House [] Commercial E] Trailer Court E] Motel 0 Other El <br /> Number of living units: Number of bedrooms __�_-_Number of baths 1---- Lot size ----- _________________________ <br /> Water Supply: Public system Community system El Private E] Depth to Water Table _j-P ft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel [:] Sandy Loam E] Clay Loam ❑ Clay E] Adobe Hardpan E] <br /> Previous Application Made: Yes E] No 6 New Construction: Yes E] No <br /> TYPE OF INSTALLATION AND.PECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available-within 200 feet.) <br /> Septic Tsnk:, tDistance from nearest well______ ------- --Distance from founclafion_---- ---------._.Maferial__._________-_________..___________-__--_--_--__. <br /> ❑ uI" Nc of compartments------ -------- ----------Size--------------------------------Liquid depth-------------------------.Capacity-_------------------- <br /> Disposal Field: Distance from nearest well-----------_---Distance from foundation--------------------Distance to nearest lot line.___.__. ..._.-_. <br /> Number of lines-----------------------------------Len`g�th`t of:each line------------------------------Width of trench---- ----------------------------- <br /> Type of filter material-------------------- ----Depth of filter. material----------.-----------Total length----------------------------•---------- --- <br /> t,.,.nt 9 - —/ <br /> Seepage Pit: Dis a ce to nearest well----A/0?%"._ istance from foundation---- ---...Distance to nearest lot line----- <br /> NJ Number of pits......../------------Lining materiaL�_t-7_6---�_4'ze: Diameter-------- Depth....... <br /> Cesspool:� Distance from nearest well----------------Distance-from foundation-_-__-_______---_ Lining material_--._____________________________-_--. <br /> El Size:-t Diameier-------------------I------------------Depth-------.`------- -------------------------- ------Liquid Capacity--------------- ---------gals. <br /> Privy: DistaTce from nearest well__________________-`---------------4-----------Dis.fance from nearest building--------______._______--_.-_-____.._--_.-. W <br /> ❑ Distance to nearest lot'1i4:_'- -------------- --•----------•--------•--r-----------------}y------------------•------------------------------------- •-------- <br /> Remodeling and/or repairing (describe):----------F------------ --------- --------------- ............------------------------------I-----------------------------------------­............ <br /> F 1r_% <br /> -----------------­-----------I----------------------------------------------------------- ------------------------------------------------------------------------I------------------------------------------------ <br /> it <br /> ----------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------- <br /> -------------------------------- --------------------------------------- ------------------------------­.­----------------­------------------------------------------------------------------------------------- <br /> I hereby certif,! <br /> w�alfnc' ha <br /> vepreparedthis application and that the work will be done in accordance with San Joaquin Count <br /> �j <br /> s� t %A1 <br /> ordinances, Staft 1ws. u,e an4 regulations of the San Joaquin Local Health District. <br /> (Signed)-------- .. .... . .......... ........ ---------- ----(Owner,and/or Contractor) <br /> -- ---------------------- -------- -------------------------------- <br /> E <br /> ----------------(Title) <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse sid^e). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED <br /> BY --------------- ---------- -------------------- ------------------------------------------- DATE-, ----------------- <br /> REVIEWED BY------------------------- ---- - - ----------------------- ------- DATE -------------------------- <br /> - ------------­------------------:------------- <br /> BUILDINGPERMIT ISSUED-----------------------------------------------------------------------------------:------------------ DATE-------11�,----------------------------------------- <br /> Alterationsand/or recommendations:------- ---------- ------ ------------------- ------------------------------------------------ ------------------------_--------------------------- - ----------- -- ' -- --- - - --- ------------------------------------------------------------------------ --------- <br /> ------------------------------- <br /> - <br /> - -- <br /> - - ...- - - ------ - - -- <br /> - --------------------------------- ------ ---------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------- ------------------------------------------------------ --------------------------------- -------------------------------------- <br /> FINAL INSPECTION By ---------- --- ------------------------------------------ Date.1- -dfC--- <br /> JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street - 132 Sycamore Street $14 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> E:5-4-2M 145446 ATWCDo 12-4 <br />