Laserfiche WebLink
Document management portal powered by Laserfiche WebLink 9 © 1998-2015 Laserfiche. All rights reserved.
4 APPLICATION FOR SANI AT ON PERMIT Permit No. ? <br /> (Complete in Duplicate) <br /> Date Issued __7/ <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 /> JOBADDRESS AND LOCATION------- ---------------------------------------------------------------------------------------------- <br /> Owner's Name----------------------------------------- a ------------ ----------------------------------------- Phone-----ya--__rl_� <br /> Address---------------------------------------------------------------------------------- --------------------------- '---------------------- <br /> / �_ } r �"' '`"� ------------------ <br /> ----- Phone------9—---�7 0--.E�----- <br /> Contrac#or's Name--------------••----•---------......----------•--• - ----- - <br /> Installation will serve: Residence � Apartment House El' Commercial ❑ Trailer Court E] Motel ❑ Other ❑ <br /> Number of living units: _1___ Number of bedrooms _I" Number of baths ---Z--- Lot size __-14S ,11___C__"-1__________________._____ <br /> Water Supply: Public system X Community system ❑ Private ❑ Depth to Water Table.,'eft.--'- <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clayam ❑ Clay ❑ Ad be El Hardpan ❑ <br /> �� /J j <br /> Previous Application Made: Yes L] No'_ New Construction: Yes E] No ❑ srtr•- F' v <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septi Tank- Distance from nearest well_________________Distance from foundation-------------------Material-_________________--__._-_-____________________-- <br /> i ------Liquid depth--------------------------Capacity----------------------- <br /> No: of compartments--------------------------Size--_--.-- - --__-.-- --- <br /> Disposal Field: Distance from nearest well_A14OX4,e�._Distance from foundation----Y---- _____Distance to nearest lot line_ <br /> ' Number of lines-------/____-_-_ Length of each line__ Width of trent .VdI <br /> � <br /> T e of filter material__ , _��� __De th of filter material_______��`�_._-_Total length__ -----_______________________ <br /> Yp !� P <br /> Seepage Pit: Distance to nearest well-J_sle_7_L4-!-----Distance fro fo dation___ ___________. <br /> � _ Distance to nearest lot'line---��_.____ <br /> Number of pits_____/____________Lining material__�____ r ---Size: Diame+er__ r_"_______.Depth---- ___________________ <br /> Cesspool:' Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------j-------------- _ <br /> ❑ Size: Diameter-- ---------------------------Dep#h---------" "-------------------- ------------Liquid Capacity----------------_----------gal . <br /> ., _._._. -- � <br /> Privy: Distance from nearest well--------------------------------------------------_ Dis#ante from nearest building <br /> I ❑ Distance to nearest lot line------- ----------- ------------- ------ -----•------------------------------------ ------------------------------------- ----- <br /> Remodelingand/or repairing (describe):------------------------------------------------ -------------------•-------------------- --------------------------------------..._---------------•- �. <br /> y ------------------------------•----•------------------------------------------------------------- --•-----------------------------•----------------------------------------•••------•--------------------•------------------- <br /> - ---------- -------------- -- <br /> -----------------•------------- - - -- - <br /> -------------------- ------------------------ ----------•---------------------------------------- •----------------------- --------------- <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 les and regulati ns of the San Joaquin Local Health District. <br /> _ (CaMwdiiirr Contractor) <br /> (Signed) " --------------------------------------------------- <br /> D <br /> Com- --- ---------------- (Title) - l. Cfi4�a1. <br /> -------------- <br /> By:--- �ing <br /> -w- - --: <br /> (Plot plan, ize of lot, location of system in r ation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-------------- ------------------------------ DATE-------------- -- �- - -------- <br /> I <br /> REVIEWEDBY---------------------------------- `' _---------- --------------------- DATE--------- -----------�------- ----------------------- <br /> BUILDING PERMIT ISSUED------------------- --------------------------------- DATE <br /> Alterationsand/or recommendations:-------------------------------------- ---------------------------------------------------------------------------"------------------------------------------- <br /> -------------------------------------------------=------------------------------------------- ----------------------=--------- ------------------------------------------------------------------------------------------- <br /> j -------------------------------------------- ----------------------- ------- ---- ---------------------------------------- --------------------------------------"----------------------------------------" <br /> F1NAL INSPECTION BY: ' Date <br /> y # <br /> If SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamoro Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M 8-51 Revised W-2100 <br />