Laserfiche WebLink
APPLICATION FOR SANITATION PERMIT Permit No.•._T�­;J.. <br /> {Complete in Duplicate} <br /> Date Issued __'4;L1_ <br /> _'4;L1_ <br /> Applica4ion 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 ounty.Ordinaryce N 549. <br /> Y <br /> JOB ADDRI SS D �O ATION �. ------ --- ----------------------- <br /> Owner's Name----- ' . --. A__t� �---- ------ ...... Phone.---•--- <br /> Address----3-A•- ----- - ------- -----U------------------------------------------ <br /> Contractor's Name.____ <br /> -------------- -------------------------------- Phone----------------------------------- <br /> Installation will serve: Residence R Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Oth;r 4 IG <br /> Number of living units: -Number of bedrooms 3.. Number of baths --1-_- Lot size �ft , � x <br /> Water Supply: Public system [�Community system E] Private E] Depth to Water Table . <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe Hardpan F]Previous Application Made: Yes ❑ No R/ New Construction: Yes o ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ' <br /> Seprti�y/�/ank: Distance from nearest well___ __._.._Dista fro founion_!.O_ Mate iajl �!f <br /> LJ g <br /> No. of compartments---------- -----------Size --__-- -_Kq�--Liquid�Oeptin_-- -_-_q------------Capacity---- + <br /> Dispos Field: Distance from nearest well..._'.... Distance fr m foundation/,�__r ".Distance to nearest lot flin ----- <br /> V, <br /> Number of lines----.-_._ - ____...__. Length of each line--------- Width of french___-_-_� .T---------- <br /> Type of filter mater' epth of filter material___-..--.�__ . __.__.Total length_________________ 0-_--___-___-.- <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation_____________-___..Distance to nearest lot line----------------- <br /> F-1 Number of pits----------------------Lining material--•--------------------Size: Diameter-----------------------Depth--------------------------------- AV <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 /> Rem ddiing and/or repair" aIrdt+ese=r L--------'--------------=----•- <br /> _f1 <br /> ------ ------ ---------------------- <br /> ______________________________________________________________________________ ______________________________________ }....__________.__________.____________.____-_-____________._______.__________.__.__________._.___.. <br /> _____________________________________________________________________________________________________________i-/_..____...__...-_--__._-_-_________________----_-___________..____....---._----..-_---------.__._-_.._ <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, S�tate�la s, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed),:�E'{� •... -------- . }Owner and -o--r Contractor) <br /> -- <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 /> REVIEWED BY-------------------------------- <br /> - --- - ---------------------- ------------------------------------------ DATE-- ----------------------------------------- ---------- <br /> BUILDING PERMIT ISSUED ----------- ------------------ ---------------- DATE------- <br /> Alterations and/or recommendations-------------- <br /> -------------------------------•---•- -------------------------------- ---------------------- -- ---------------------------------------•----------------•---•-------..-------•------------------------------------------ <br /> ---------•------------------------------------------------- ----------------------------------------------------------------------------------------..-----------------------------••--•---------------------------------- <br /> ----------------------•----------•-•----------------------...------------------- ----------- - - ----------------------------------------------------------------------------•-••------------------------------------------- <br /> - --------------------- -------------------------------------------------------------------------- ----- --- -----------------------------------------------------------------•--•----••-----•-------- <br /> FINAL INSPECTION BY:----- 4 --------------------------------- <br /> 1 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-9-2M 145445 AT.0-C <br />