Laserfiche WebLink
APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) Date Issued <br /> Applica4ion is hereby made to the Son Joaquin Local Health District for a permit to construct and <br /> This application is made in compliance with Cou Ordinance No. 549, not install the work herein described. <br /> 1~ <br /> pty Ordi <br /> JOBADDRESSANDL. f. Iwia&oe <br /> Owner's Name..... . �PCATION <br /> 0, &...... . . ------- <br /> ............. ........ ... ..... Phone... ... . <br /> ............................. <br /> Contractor's Name..... <br /> ................. <br /> ----- ------- - ------ -------I.... Phone <br /> Installation will serve: Residence UR- Apartment House E] Commercial E] Trailer Court E] Motel 0 Other El <br /> Number of living units; Number of bedrooms 07-1- Number of baths Lot size 1110C-414---__- ------ <br /> Water Supply: Public system ❑ Community system 0 Private 0-'6epth to Wafer Table <br /> ,9. 9 ft. <br /> Character of soil to a depth of 3 feet: Sand Ej Gravel [] Sandy Loam E] Clay Loam 94*Clay E] Adobe C) Hardpan El <br /> Previous Application Made; Yes F <br /> I No �' New Construction: Yes g}-'No D <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Lj <br /> Septic Tank: Distance from nearest wqII.N;r_jP.. ...Distant f m foundation..../01.........lvlal�erial.. .0 <br /> No. of compartments.... - I ..11 Z...- <br /> _44-44.. <br /> Size.V�,x.y-o,Liquid Capacity....'Pow <br /> Disposal Field: Distance from nearest . ..... D:starce from fcundatl <br /> oG ------ -----Distance to nearest lot line_140 <br /> Number of lines— -------- <br /> Type of filter materia i. ... ...... Length of each hne-_. ..Width of french _- <br /> .,".Depth of filter material. Total length- <br /> ­111­11�...... ... <br /> Seepage Pit: Distance to nearest- we!!.. 71e �_ <br /> EJ Number of pats.-.... _....-..Distance from foundation....-......... ---Distance to nearest lot line. <br /> Lining material.... ........... ....Size: Diameter............. <br /> Cesspool: Distance from nearest weil......... .... ..Distance from foundation............... ........Depth. .__... .................... <br /> ...Lining maferial- ...................... __ <br /> size: . .... <br /> Diameter..... <br /> .....Depth. ......... .. ....... <br /> ...................._Liquid Capacity.. <br /> .........gals. <br /> ........ ... <br /> Privy: Distance from nearest well.. .. ..... ... ---- - ... ....Distance from nearest building...... ... .... .......... <br /> ❑ Distance to nearest lot line..-"----- ---------- <br /> Remodeling <br /> .....Remodeling and/or repairing (describe):...........).24" <br /> ......... . <br /> .............................................................................. ------ -1 --- ----------------------------I-------------------------------- <br /> ..................I............................................................ . ........­............ . ............... ... ................................... ..................... <br /> ---- --------------------------------------------------- <br /> .......... ............ ........... ..............................­....­ ­­.................. .......... .... ........... <br /> I hereby certify that I have prepared this application and that t work will 6eone in ac rdance with San Joaquin County' <br /> ordinances, State laws, and rules and regulafi s of the San Joaquin Local Healfhf'Disfric+. c <br /> (Signed)....................001! 0 <br /> igned .....W....011'!t,�. _ ---- - .-. . — . ..... - ----------- ---- -- Cor) <br /> By:................. .................. X. _(Title)-_ ant ract <br /> (Plot plan, showing size of lot, <br /> locati f system in relation to wells, buildings, etc., can be placed on reverse de). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY.!- ---- ­ ... ... . ...... .. . ......... .................... ..... DATEI�_ <br /> REVIEWEDBY......... DATE._'t��---------------------­­*------------------- <br /> - ---- -- ------- --­----------­--------- ----- <br /> BUILDING PERMIT ISSUED_...- ........­*......­*------------------— - <br /> _ ------ ---------- ----------- ------------------------------------------------------ DATE---and/or recommendations:........ .......... .... ...................................... <br /> .............................. ...... <br /> 7................................ <br /> ........... .......... ..... ..............—...........................I.......................... <br /> 44 ------------------------ <br /> ...... . tj <br /> ........................... <br /> ...... ­_----- & i X. <br /> ...... X. Q:1!:1.1_.J.-1 ............�x <br /> ......................... .......... ............. T - ............................................................................ <br /> ........ . ............ .... .. .. . (-:-j <br /> .................... .......... ........... ......... ..................... ........... ........... .......... . .................. ...................... ......... <br /> ...... ....................... ......... ......­­­........... ..... .... ..... ..................................... <br /> FINAL INSPECTION BY: <br /> ..... ........... . Date., <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Sfrest 300 West Oak Street 132 Sycamore Street $14 North "C" Street <br /> S?ockfori, California Lodi, California Manteca, California Tracy, California <br /> M <br />