Laserfiche WebLink
APPLICATION FOR SANITATION PERMIT Permit No. .6----_ 1.._... <br /> i . <br /> (Complete in Duplicate) Date Issued ._��--- <br /> Applica4-ion 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----------Y-ql - ;" - <br /> Owner's Name-,irl- ------------4!!E'er !✓------------- ------------- ------ Phone-- G = 3 ►- - <br /> Address.-_--------17-14 1-----------//��� Q U _ - p--------------------------------------•-•---------------------------------- ­---------- <br /> .-......�'71�„�t n.- s---- �"---- --rYr� -- Phone----------------------- - <br /> Installation will serve: Residence [a Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -1----- Number of bedrooms _- - Number of baths --;�..._ Lot size ------4z_0--------X...1__ __ _________________ <br /> Water .Supply: Public system ❑ Community system ❑ Private 0 Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe R Hardpan ❑ <br /> Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No sepfic,fa4 gr cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tan istan• from nearest well % -_-__Distance from foundation--------------------Material-------.--------------_-.----_-----.--__---.-----. <br /> ❑ No. o compartments--- ---------- ----------Size----------------------•-------.-Liquid depth---------------- ------.--Capacity---------------------- <br /> Disposal Field: Distance from nearest well Distance from foundation_--- -------Distance to nearest lot line.--/-T' ------- <br /> ( ----►--.----..Width of trench--_--�-- --ii------ <br /> Number of lines___-------,�._. ---rt Length of each line __- -_ <br /> Type of filter material..-/_3___..?�epth of filter material-----/-.-_-----_.---Total length-_-_---_ --- ----------- <br /> Seepage <br /> Seepage Pit: Distance to nearest well 9 Q-.---.-_Distance from Apur3clation....F.0---------Distance to nearest lot line-- -_�_----_ <br /> Number of its.-..---/-------------Linin material-�.G_ <br /> p� g ------. e: Diameter--�.�.- -- ---Depfh___012_1!6------------------- <br /> Cesspool: Distance from nearest well----_------------Distance from foundation.-- _Lining material---.----___----__---_-_--____--___-. <br /> E] 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)--------------------------------------------------------------------------------------------------------------------........_---------------------------- <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> --------------------------------•-------------------...---•--------------------------•-•----------•-•---.........-----------------------------------------------••------------------------------------ <br /> I hereby certify the+ 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] �QPw--L 2 ��----- ---------- ----• ----------------------------- --- O ner 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 /> REVIEWEDBY------------------------------------------ ---- ------------ -------------------------------------------------------- DATE------- --- <br /> BUILDINGPERMIT ISSUED------- ------ ------- --------------------------------------------------------------- DATE---------------- -•--- -- ---_-------- <br /> Alterations and/or recommendations:-------------- ---------- -----------------...--------------•-------------------------------------•--•--------------- ----------14.................... <br /> ------------ ----------------------­--------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------- <br /> - -- ---._ <br /> „ t <br /> FINAL INSPECTION ---------. Date.---- <br /> ---------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 014 North "C' Street <br /> Stockton, California Lodi, California Manteca, California 'Tracy, California <br /> ES-9--2M Revised W-2100 <br />