Laserfiche WebLink
30/ ;. <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete in Duplicate) <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. 549. <br /> JOB ADDRESS AA LOCATION----Z%?/- -- --� _ ----—------------------------------------------------------------------ <br /> Owner s Name ! • -------------- Phone------------------------------------ <br /> -------------------------- <br /> Address--- - ------ --- <br /> Contractor's Name_ '-.- .. " -------- Phone- -! <br /> ----------- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: Number of bedrooms Number of baths Lot size_- ' __..__ _--_ _ .----_-_--_- <br /> Water Supply: Public system Community system ❑ Private 0' <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [] -Clay ❑ Aclobe�( Hardpan ❑ <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__ __Distance frodation----_ ------Material------------------------------------------------�' <br /> y� No. of compartments---------�.....-___ Ca aci 7 !' <br /> 7�` p tY ------------ Size ' - ��" Liquid depth-- - -------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-_-------_--_--_--__-----____--____ <br /> ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------- � <br /> Privy: Distance-from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ <br /> El Distance to nearest lot line------------------------------------------------ <br /> Seepage Pit: Distance to nearest well---277=--------Distance from foundation---- -__.Distance to nearest lot line------------------ <br /> Number of pits--------/-----------Linin ?�material_� ---Size: Diameter__X_eef�---------Depth____d7to.. <br /> Disposal Field: Distance from nearest welk---•..,______Distance from'foundation_---!?tr��--Distance to nearest lot line__1--�_ <br /> Number of lines--------------/-------------------Length of each line-------- --------Width of trench-__rte-4 .................. <br /> Type of filter material---- - -______---Depth of filter material---- {-:- <br /> Remodeling and/or repairing, (describe):--------------------------------------------------------------------------------------------------------------------------------------.---------......... <br /> --------------------------------------- ------------------------------------------------------ -------------------------------------------------------------------------------------------- ------------------ <br /> ---------------------------------------------- --------------------------------------------------------------------------------------------------------------------------.-------------------------------------------- , <br /> ---- -------------------------------- ----------------------------------------------------------------------------------------•--------------------------------------------------------­­------------------------------ <br /> I <br /> 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 ond rules and regulations of the San Joaquin Local Health District. <br /> � e - <br /> (Signed}-- -- __r ----------- " ---- /or Contractor) <br /> ---------------------------------------------- <br /> 1 <br /> By:----- --- ------ -or------------------------ <br /> - - -------------- - - ------------------------------------------------------ --- .(Title-- --- <br /> (Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be filed with this application). <br /> FOR DEPARTMENT USE ONLY <br /> • � r <br /> APPLICATION .ACCEPTED BY---------- F---.Y-------------• ------------------------------------------------- DATE------ <br /> REVIEWED BY------------------------------------- <br /> - ------ <br /> ----------------- ----- ------------------------------------- DATE------------------ - <br /> BUILDING PERMIT ISSUED--------------------------------------------------------------------------------------------------- DATE--------------------------------------------- - <br /> Alterations and/or recommendations-=----------------- ----------------- ------------------------------------------------------------•-----------------------------------•---------------- <br /> -----------------•------------------ ---------------------------------------------------------------------------------------------------------------------------------------------•----------------------------------------- <br /> --------------------------------------------------------------------------------------------------------------------------------------•--------------------------------------------------------------------------------------- <br /> ------------------------ -------•----------------.--------.-------------------------------------------------------------------------------------------------------------------------------------------- --------------- <br /> PERMIT No_---- � ------- ISSUED------ ----------(Date) FINAL INSPECTION BY:.-------- :,p/ <br /> Date---------- ! <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street a t° <br /> Stockton, California <br /> ES-9-2M 9-50 W-1639 <br />