Laserfiche WebLink
FOR OFFICE USE: ` <br />--------- -- -------------------- --------------------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. ..... <br /> �../. � ' <br /> ------------ ------------------------ (Complete-in Duplicate) r <br /> __ _______ _________ __-_-...__..__. This Permit Expires 1 Year From Date Issued <br /> Date.lssued ��-�---- <br /> Application 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 /> JOB ADDRESS AND LOCATION. -'r► ---- --- __ - <br /> Owner's Name---•--- _.. � - - -•-------...._ --------- Pkone <br /> Address- 1-0-62.,5 _.` 1�� = 4 = =-- ----------------------- <br /> + ------ . . d---- --- Phone....... <br /> Contractor's Name-------- -- •- •-- ------ ------ - <br /> Installation will serve: Residence �Apartmen House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> ter Supply: Publicgs stem � Community system ❑ �Private Depth to Water <br /> size ----- __ .._____. ---------------__.______.______.--_-._._ <br /> Number of living units: -- _____ Number of bedrooms -.. .--_ Number of baths._k <br /> Wa pp y y ❑ y y Table ------ - ft ` <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date-.................. J No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <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 /> ❑ No. of compartments--------------------- - --Size------------------ -----------Liquid depth -------- ------ --------Capacity--•-------------------- <br /> Disposal Field- Distance from nearest well.................Distance from foundation--------------------Distance to nearest lot line--- <br /> 0 <br /> ` <br /> ❑ Number of lines--------------------------- ------Length of each line-- ---------------------------Width of trench..--------------.-__..._____--._-- �? <br /> Type of filter material-------------------------Depth of filter material----.------------------ otal length---------------------_._-------_--__----.- <br /> age i : Distance to nearest wI _ell____ 4_P.._._._._Distance from foundation-----1 4-_--_-.--.Distance to nearest lot line----------------- <br /> Number of pits.-- ------F-___----...Lining material------ -_ Size: Die irter-�_'X_/V.'---Depth....1-F_/------------------- <br /> Cesspool: Distance from nearest well ----------------Distance from foundation... _.Lining material--------------------._-_----_-..---_-. <br /> ❑ Size: Diameter- -- --------- ----- ---------------Depth-------- ---------------------------- --------------Liquid Capacity-- ---------------------....gals. <br /> Privy: Distance from nearest well. .....................................Distance from nearest building-------------------------------........... <br /> ❑ Distance to nearest lot line .............. ------------------------------------------------------- ----------------------------------------------------------- <br /> Remodeling and/or repairing (describe : ---- =- - - ----------•-- --•-----------------------• ► al <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, Stat411aw and rules and regulations of the San Joaquin Local Health District. <br /> --(Signed}--------•------ - --------- <br /> --- --- Pxner.and/or Contractor) <br /> BYl - -��` '-_.__-_----- --- ------------------------------- {Title) - <br /> (Plot plan, showing size of loft, location of system in >�elation to wells, buildings,-etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY._. ----- <br /> � .._ <br /> -- -- - -- - - -- - ---- - ------- -------------------------------------------- DATE.-A-- --- ------11---4-- ------------------ - <br /> REVIEWED <br /> --------------- - <br /> REVIEWEDBY----- ----------------------------- ------------------------------ --------------------------------------------------------- DATE--:-- --------------------------------------------------- <br /> BUILDINGPERMIT ISSUED-------- -- -------- ---------------------------------- --------------------------- ------------ - DATE-------------------------------------------- ---------------- ,. <br /> Alterationsand/or recommendations- - ---- ---------------------- - ....------------- ------•-------------------------------------L----------••------- ----------------------------------------- <br /> ' Date I--� -.d-_ -�-�--- - - --- --- ------------------- <br /> FINAL INSPECTION BY:.._ - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 20.5 West 9th Street <br /> Stockton,California Lodi,California Manteca, California Tracy,California <br /> E.H.9 2M 1.67 Vanguard Press <br />