Laserfiche WebLink
nPermit No. <br /> APPLICATION FOR SANITATION PERMI,,-.. <br /> (Complete in Duplicate) Date Issued <br /> Applica+ion is hereby made to the San Joaquin Local Health District for a permit to constru t install t� <br /> f an wok hyein described. <br /> This application is made in compliance with County Ordinance No. 549. ?.O"t" - , A --- <br /> --------------------- <br /> ----R41t. <br /> JOB ADDRESS AN ATION---------41 <br /> 11�_ 1_7__;� <br /> Owner's Name---------------------------------- ------- ----------------------I-------------------------------------- Phone------------------------------------ <br /> <7 <br /> Address----------------------- -- ------ --------- --------- ------- ------------------------------------------------------------------------------------- <br /> ------------ - ---- -------------- <br /> __1----------------------- Phone 25.i� <br /> ---------- ------- <br /> Contractor's Name... ----V-v k� �- <br /> Installation will serve: Residence [P�-_ApartmeJ House Ej Commercial E] Trailer Court 0 Motel E] Other E] <br /> Number of living units: Number of bedrooms --'L--Number of baths __/--- Lot size -----2-0---- -—------------------------- <br /> Water Supply. Public system E] Community system E] Private Ed-ADre-pth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam -,. Clay Loam E] Clay E] Adobe Ea--tl-ardpan ❑ <br /> Previous Application Made: Yes [:] No [? New Construction: Yes Loam <br /> U <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic lank or cesspool permitted if p blit-sewer is available within 200 feet.)___.y, <br /> Se }is T nk:9 Distance from nearest N ------ Distance from foundation__ _.__.____..Material_S e on-- erial- . .... . ...... <br /> ✓ <br /> No. of compartments el- Liquid deptk_Z5,_,f Capacity_,,-"_,�_'_��Y!q4- <br /> OU a <br /> Disposal Field: Distance from nearest well D',s?a_,c7 41 ou ation----/10-' Distance to nearest-lot-line________ _,S. <br /> or lines_____ -Length of each line___,d��---------- ........Width of french.- -------------- <br /> Number I I �)--------1Z-----U----- <br /> Type of filter material-___..3r._._-....j___-Depth of filter material..../._ ----- Total length-------Z_Y6��--------------- <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation.....................Distance to nearest lot line_--_.._--_--.-_.. <br /> ❑ <br /> ine----_--------- <br /> F1Number of pits----------------------Lining material-----------------------Size: Diameter_---_---....-----------Depth--------------------------------- 141* <br /> Cesspool: Distance from nearest well-----------------Distance from foundation.-------------------Lining material_--_..._____-..--_--_--_---_-._---.--. -� <br /> ❑ Size: <br /> aterial-------------------------------------- <br /> Size: Diameter------ -------------------------- ---Depth--------------------------------------------- ------Liquid Capacity----------------------------gals. <br /> Privy.- Distance from nearest well-------------------------------------------------Distance from nearest building---------------------_-------_---.-------. �� <br /> ❑ <br /> uilding--------------------------------- -------- <br /> 0 Distance to nearest lot line.- ---------------------------------------------------_-- ---------- <br /> -------------------------I------------r----------- <br /> Remodelingand/or repairing (describe):-------- ---------------------------- -- ------------------------------------------------------------------------------------------------------------- <br /> ----------------------------- ------------------------------------------------------------I--------­­-------------------------------------------------------------------I-------------------I---------------------------- <br /> --------------- --_----------------I------------------------------------------------------------------------------- ------ -----­--­------I——----------------------------------------------------------------------- <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 San Joaquin Local Health District. <br /> (Signed)-------------------------------------------------- -------------------- Contractor) <br /> ---------- ----------------------- <br /> By:------------------------------------------------------- -----------------(Title) --------------------- <br /> (Plot plan, showing size of lot, location of system in retatpin to wells, 6uildin4st etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------------ - -- ----------- ------------------------------------------- DATE------- -------------- <br /> REVIEWED BY---------------------------------------- ------------ T <br /> ------ ----------------------------------------------- DATE--------------- ------------- .......__­___------------ <br /> BUILDINGPERMIT ISSUED------------ -------------------------(-------- --------------------------------------------- DATE_.--------------------------------------------------------- <br /> Alterations and/or recommendations: ------ - --------- ---------------------------------------------------------------------------- <br /> - ------4__,__—, __ -------------------------------- <br /> 7 <br /> ----------------- .-/_-z----" ------- �7........ i5----------------------------------------------------------------- <br /> -- ------------------------------- ------------------------------------------------------------------------------------- <br /> ------------------------ ------------------ -------- -----------­....... --- - --------- <br /> --------------------------------------- ------------------- <br /> ----- ------------------------------------------ ----------- ------ - - -- ----- .......... ------------------ ------ - ------------------------------------------------------------- ------------------------ <br /> ---------------------------------------------- ---------------------------------------------------------------------------------------------------- <br /> I <br /> FINAL INSPECTION BY:.-- Date---------------------- ---------- ---- ----------------- ---------------------- <br /> ------------------------------ --- <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 /> 145446-... 1-54 <br />