Laserfiche WebLink
>>y APPLICATION FOR SANITATION PERMIT Permit No. ..... .Sd_-S <br /> (Complete in Duplicate) <br /> Date Issued :,3_`,S <br /> Application is hereby ade 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. 54499.` <br /> JOB ADDRESS AND LOCATION---------- ------------------------------------------------- <br /> Owner's Name---------------------------...... «?- -ar I A ` .c..-------------- ------ ---------------------------------- Phone---,;- -----E <br /> Address-------------- ------------------------ ��`'---------`----------------------------------------------------------------------------------------------------------------------.-------- <br /> Contractor's Name----i------------------------- . -- .. ------------------------------------------------------------ Phone------7----_�47-R-7 <br /> Installation will serve: Residence jg— Apartment House ❑ Commercial ❑. Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _ __ Number of bedrooms _. Number of baths I..... Lot size ___ r -: t` _t _----__._-._-.____- 1 <br /> Water Supply: Public system �9,.Community system. ❑ Private ❑ Depth to Water Table <br /> Character of soil to a,depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe_, Hardpan ❑ <br /> Previous Application Made: Yes ❑ No ,.,New Construction: Yes*, No ❑ I <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> ,}-0, <br /> Septic Tank: Distance from nearest well-A-14 Distance from foundation-11t---------Material__.�' •�5 ------------ <br /> No. of compartments_..__ -____ r Size__R____: b_.-_-Liquid de0h__,4•=_:)-r .........Capacity_ f'v_4?,5_ '- <br /> - t <br /> Disposal Field: Distance from nearest,Gbell ,, ..-.Distance from ou 'dation.-. - --._.Distance to nearest lot line----- <br />_ Number of lines------- ------------------Length of each line___-_--Z-2 —''____..Width of trench 4" - <br /> --------- <br /> Type of filter materia,/_X _`f °1_ '" <br /> yp .,_ _�Depth of.filter-material___._._./ Total length_________.____ ____________._ <br /> ✓' s '`'r^ <br /> Seepage Pit: Distance to nearest w 17-S--------- <br /> fro foundation-_- -__.Distance to nearest lot line ._- _...___ <br /> Number of pits----. -----_--.._--Lining material_�_F_/_..a4• dk.Size: Diameter_. .._;_!!___.Depth _._ -��E ............. <br /> Cesspool: Distance from nearest'well------------------.Distance from foundation_=_W#`_______._Lining material--------------------_.____--_-______- <br /> ❑ Size: Diameter--------------------------------------Depth---------,.------------------------------------------Liquid Capacity-.,.'-.----- -------gals. <br /> Privy: Distance from nearest well---------.------------_______-_--.-__--- __Distance from nearest building____.__-_-._______--______.__-_.-__---. <br /> ❑ Distance to 'nearestlot line----------------------------- ---------------- --------------------- •----------- <br /> . <br /> Remodeling rid/or rep .iri g (describe):__._ �----j`z 4'� <br /> jf^ F1 <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 regulations`of the Sen Joaquin Local Health District. <br /> } <br /> (Signed) -------------------------------------- � -- � __..__.___---.___.___________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 /> --- - -- -- - -- - - <br /> --------------------------------------------------- <br />.. REVIEWED BY ---------- ------------------------=----------------=-------------------------------------- DATE__t�------ ------------------------------------- <br /> BUILDING PERMIT ISSUED----- --------------------------------------------------------- ------ DATE--------V---------=----------------------------- <br /> Alterations and/or recommendations > r f .-_•__________--------------------------------- <br /> . -• -•-- .. •------- .. �,.. ... ------------------------------------------------------ - -------- ........ ------ -------- --------- <br /> ---------------------- ---------- ----- <br /> ---------- <br /> ---------- <br /> FINAL INSPECTION BYE,_.. . .-•_---�_--- --"-"� "" <br /> - ----- ----- ------------- 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 <br /> ES-9-2-Ma 10-52 Revised W-2100' <br />