Laserfiche WebLink
, <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> .............. <br /> (Complete <br /> (Complete in Duplicate) Da+e Issued <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 withy Ordinance No 549. <br /> '2.SS 1 N• tfocx yy 061f,- <br /> JOB ADDRESS AND L CA ON-.2 .._..?,,cur, <br /> dn:2�Q"xtt- ' ''�= --------------------- <br /> Owner's Name... <br /> �� ------------•-- Phone-------------------_------------- <br /> .._!!J,! f <br /> Address--------------ta_S�--- -__te .x- -J.- •------ --•----------•------------•----------------------•-------•--•-----••--------. II// jj - -..._ <br /> Contractor's Name............. Phone-----�`�.0-- -.• .-. <br /> Installation will serve: Residencel--t� Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _.1._:: Number of:bed rooms-?':_ _s umber-of baths I.... Lot size ---- <br /> Water Supply: Public system ❑ Community system ❑ Private NJO" Depth to Water Table 1.1ef+. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam❑ Clay Loam ❑ Clay❑ Adobe ' Hardpan❑ <br /> Previous Application Made: Yes ❑ No New Construction-. 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.._ .Distance from foundation-___ <br /> W4 No. of compartments--------9.-- Size-.-.q- � ..----.._..Ca Capacity �-� �� _- --- iquiep ..._ <br /> Disposal Field; Distance•from nearest well.._4_,tr._.-.Dis+ance from foundatian....�--.-. Distance to nearest lot line. -.__ <br /> Number of lines_..___.. ength of each liiie.l�.�i? .'1�''.�- �.--�Nidth of treneh .l.+.................... <br /> Type of filter material__,S._.�epth of filter material... .............Total length----•- ----•- <br /> •,Seepage Pit: Distance to nearest well----------------------Distance from foundation........._..........Distance to nearest lot line._.___._.._..._ <br /> ❑ Number of pits..._..._---------_-Lining material_---.--.--_----.----Size: Diameter.......................Depth.........._............--.__,_. ; <br /> Cesspool: Distance from nearest well-__:_.__...._..-Distance from foundation..........----------Lining material--_...-_--_____--_____-_--_-_ .I <br /> ❑ Size: Diameter------------. .._.Depth-............... ----.__-_._.­Liquid Capacity .---_---941s. <br /> Privy: Distance from nearest well__-----------------------------------:-----__Distance rom neores 6uililin j'_"___......_..._.__.._._:..- <br /> ❑ Distance to noarest loft line. �--.-..--------- <br /> i -40 ..... - - <br /> Remodeling and/or re firing (describe):._._----.-.................__------- <br /> -_-=--•---,-•--- <br /> --------- -------------------- ---. •-...A...-------_---------. .^--- ....... ------............_........------••---....-•---------................................ <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 nd regulations of the San Joaquin Local Health.District. j <br /> x ��_A _. ._.. { ) I <br /> �'(Signedl - .•I 6 _m�� •` ' - and/or Contractor) <br /> or � <br /> BY:---........—--------........- .......--1....._..............................---------•---•--- --------- - {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 /> APPLICATIONACCEPTED BY..._., ----------------------------------........................--- DATE---...... -----•-----------------------•---------------- <br /> REULEWED BY_ _. _ - _ - - - - - _ - <br /> DATE-- <br /> _ _ _. - <br /> BUILDINGPERMIT ISSUED.............•.._.. .................................................... ......... DATE - <br /> Alterations and/or recommendations:..._.___.. ...............................................---------------•---------------------.--.-------•-..._...._._.---..-------... <br /> _..---•-•-•------------------------••---•---•-•-- <br /> --------------------------------------- ___ - ........... ........_..........----. _-•---...------------.......... <br /> _- ----------------..------._ ..... <br /> ----- <br /> --------•--••----•------ -•-•-----.-----•---•---•-- <br /> FINAL INSPECTION BY:............. ._ . ..._.......... Date <br /> .r _-...1-�_�'� - ..---.........-- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> f 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California ?racy, California <br /> ES-9-2M 8.$1 Revised W-2100 <br /> - 'J <br />