Laserfiche WebLink
APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) Date Issued <br /> Applica+ion is hereby made f the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance h County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATIO --------- ------- ------- <br /> -----et,4046---------------------------------------------- <br /> Owner's Name.- ------- -FeeAz------ ---- - - --- ---------------------- -------------------------------- Phone...------ <br /> ------------------------- <br /> Address... <br /> Z, je -a—---------------- -------------------- ---------I-------------------------------------------------------------------------- <br /> Contractor's Name----- — ----------------------------------------------------------------- ---- ------------------------------------------ Phone----------------------------------- <br /> Installation will serve: Residence Apartment House E] Commercial [:] Trailer urt Motel Other E] <br /> o <br /> Number of living units: ----- Number of bedrooms _'Number of baths?--- OT size r" �-------- <br /> Water Supply: Public system El k.Community system D PrivateX Depth tl/Water Table ---W. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loom El Clay oam Ej Clay ❑ Adobe Hardpan E] <br /> Previous Application Made: Yes E] , Nox, New Construction. YesXNo <br /> TYPE OF INSTALLATION AND:SPECIFICATIONS: fl <br /> (No septic tank or cesspool p6rmiffed if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well--,- - _--Liquid depth--------------from ioundation-----/-p-------M feri ------ <br /> a p <br /> 4 <br /> No. of compartments--------------------------- TL--------Capacify.,----9--0-------0 <br /> ----- <br /> Disposal Field: Distance from nearest well-__/,0.0--_Distance from foundation-_/--- -----I---Distance to nearest lot line... <br /> - Number of lines_-_----/--._...-._-_-.-.-_______Lerigth of each -------Width of trench--------I <br /> . .. ....Type of filter maierial-_5717A�"AlDepth 'of filter material------- e-,*---Total length----------- <br /> Seepage Pit: Distance to nearest weft---------------------Distance from foundation--------------------Distance to nearest lot line_----.--___-----_ <br /> ❑ <br /> ine----------------- <br /> ElNumber of pits----------------------Lining material...------_----------.Size: Diameter------------------------Depth---m----------------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material--_-_---_---__--. P <br /> ❑ Size: Diameter............. .......................-Depfh-------------------_---__--------------- -------Liquid Capacity..--•-----------------------gals. r, <br /> Privy: Distance from nearest well-__._............ ......._---____._.__---__-Distance from nearest building--__. .______________________ ..______0� <br /> ElDistance to nearest lot-line-----------------------------• --------------------------------------------------------------------------------------------------------------- b <br /> Remodeling and/or repairing (describe):------- ...... ------- -------------------------- -------------------------------------------------- ------------------------__----------------- <br /> ---------------------------------------------------------------------------------------------------------------------------------- ------------------ ------------------------------------------------------------------- <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------ ----------------------­­-------------------------------­---------I------------------------------------------------------------------------------------------I------------------------- <br /> I hereby certify that I have.prepa;ed this application and that +he work will be done in accordance with San Joaquin County <br /> ordinances, St aws, a ,rules <br /> ,n and regulations of the San Joaquin Local Health District. <br /> (Signed). 4ee ---- -----I-- --- ---- ---------------- ------------ ------------------------ ---------------------------------(Owner and/or Contractor) <br /> By:------------------------------------------------------------------------------------- ------------------------------------------(Tif le)----------------------------------------------------------- <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 /> APPLICATIONACCEPTED BY---------------------------------------------------------------------------------------- ------------------------------------------- DATE---------------------------------------- r <br /> REVIEWED <br /> ATE---------------------------------------REVIEWED BY--------------------------------- a---------------------------------------- DATE------- - r - <br /> BUILDING <br /> ATE-------- <br /> BUILDING PERMIT ISSUED DATE------------------------------------------------------------- <br /> ------------ GP& <br /> ---------------------------------- <br /> Alterations and/or recommendations:-------------- ------------------------------- --------------------------------------------------------------------------------------------- <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------I--------------------­------­ <br /> ------------------------------- --------- ----- --------- ----------------------------------- ------I-----------------------------------I---------------I------------------------------------------------------- <br /> -----------------•---------------------•-------------------------------------------------- --------------------------------------- ---------------- ----------------•------ -------------------------------------------------- <br /> -------------- ------------­_------------------ ------- ------------------ -------------- --------------- ------------------_---------------- --------------- <br /> ------------- --- <br /> FINAL INSPECTION BY-------------- -------------7--------7-- ------- 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-9-2M 145446 ATWOOD 12-S4 <br />