Laserfiche WebLink
FOR OFFICE USE: <br /> ---------- ------- ---------------------------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. ....)... ............. <br /> ---------- -------------------------------------------- (Complete in Duplicate) f <br /> This permit Ex fres 1 Year From Date Issued Date Issued ---4_-0....... <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. 54 . <br /> JOB ADDRESS AND L CATIO AIA2__ -----Id+,? .' <br /> Owner's Name------ --- - ---•--- ' - Phone----••-------------- --- <br /> Address------------ / - -- ------ -- ------------------------------------------------------I------------------------------------------------------------I......................... <br /> Contractor's Name------------- r-------------------------------------------------."....----------------------------. Phone.................------------------ <br /> Installation will serve: Residence ,Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _I__ Number of bedrooms.,-^-_ Number of baths ../__ Lot size -________________________ <br /> Water Supply: Public system ❑ Community system ff Private ❑ Depth to Water Table _ ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [❑ Clay ❑ Adobe lardpan ❑ <br /> Previous Application Made: (If yes,dote___________ ________I No ® New Construction: Yes gg-'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__y�____Distance foundation___ ____________.Mat0 'al---- _ -_ _ ------------------- <br /> No. <br /> _____- -___._.___No. of compartments-----Zr____-___-__.-_Size _fhA___� -------.Liquid depth___ Cap acity---4�-___- <br /> Disposal Field: Distance from nearest well------- ✓-----Distance from foundation./19----------- <br /> Distance to nearest lot line.%5........... <br /> 2?' Number of lines e___ Length of each line___�.�'___� Width of trench_..A--------------------------- <br /> of filter materialf� i __' p length---- <br /> Type / \ <br /> _-_-_,Depth of filter material__-�__-_______._Total ._r��L _______________________ <br /> Seepage Pit: Distance to nearest well--------- ________Distance m f undation___�, _.______-_.D' t ref to nearest to line.f.__.......... <br /> Number of pits-----/._____.______Lining material_ _ _ ___.Size: Diameter__. 3-________Depth-__ tg_ 7 ______________ <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):--------- ----- --------------------------.----------------------..-•------------ <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 I;aws, and r les and regulations of the San Joaquin Local Health District. <br /> r <br /> (Signed)----------------- / ------ (Owner and/or Contractor) <br /> ------- --------------- - ---- - - --- ------------------- <br /> �r yf --- /r <br /> By:------------------------------------------------------------------ ----- - - ----- -------•---------(Title) (/ <br /> - - ---- -- ----------------------------------- <br /> (Plo+ plan, showing size of lot, location of sys+e 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---------------------------------- ----•-•----------------------------------------------------------- DA-TE------------------------------------------------------------- <br /> Alterationsand/or recommendations:--------------------------------------------------------------------------------••---------------------------•--------•----------------_------------------- <br /> -------------------------------- -------------------- --------- ------ ----- -------;------------------ ---------------------------------------------- <br /> '�`r 7 ` s ---- - L- --------- -.-� ------------------------------------------------------- <br /> ------------------------------------------------ <br /> ----------------------------------------- -------------------------------- ----- ---------------------------------------------------------------- --­------I-------I----­­---------- ------------------------- -------- <br /> ---------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- ------- <br /> FINAL <br /> ----------------------------------------------- <br /> FINAL INSPECTION BY:.-_ _C. __:_. - -tcr- Date-----_-C_.- -- r_ / <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lod],California Manteca,California Tracy,California <br /> ES-9 REV18E0 8-59 r.F.00.TM 6.60 <br />