Laserfiche WebLink
FOR OFFICE USE;- O <br /> 1 APPLICATION FOR SANITATION PERMIT Permit No. <br /> ...� ---- <br /> -�-` <br /> ---------------------------------------------------------- <br /> (Complete in Duplicate) l <br /> -----. This Permit Expires 1 Year From Date Issued Date 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 with County Ordinance No. 549. <br /> JOBADDRESS AND LOATION_...__--------------------------------------------------------------------- ------------------------------ <br /> Owner's Name---- ------•-••-----•------------------- - - - - ------------------------------------ Phone----•------------------------•----- k <br /> Address. --- Z--------- <br /> ��G ---------------------------•--•--------------------------- 4 <br /> Contractor's Name__ ---- ------ ------------------------- -------------- Phone----------------------------------- <br /> Installation will serve: Residence ;) ` Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _!.. Number of bedroomsv_Z._ Number of baths -------- Lot size ------------------------------------------------------------ <br /> Water Supply: Public system JX Community system -❑ Private ❑ Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feef: Sand-❑ Gravel.❑ Sandy-Loam ❑* Clay Loam ❑ Clay [❑ Adobe X_ Hardpan ❑ <br /> Previous Application Made: (If yes,date--------------------J No New Construction: Yes 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 /> Sept�Tank: Distance from nearest well_.-5 .__ Dista c f o fo tion__f _._._._. Material______.__.____________________ <br /> ��- j <br /> No. of compartments----- �-_- Liquid depth-----'ll_______________Capacity___ <br /> Disposal Field: Distance from nearest well. �_�-._Distance from foundatio � --------Distance to nearest lob line-------------- _ <br /> Number of lines-_-_,.?----------------- Length of each line------- Width of trench _�._-_f--��_________--- j <br /> Type of fiber material_! -Depth of filter material___ length---._- ----r------------------------ <br /> Seepage Pit: Distance to nearest well----- from f undation-.-_f`J-- ____Distance to nearest lot line-_ $ r Da <br /> �( Number of prts___o:"-1.-----------Lining material_ ____.Size: Diameter___._��r .. Depth__.. _J' � <br /> Cesspool: Distance from nearest well-----------------Distance from foundation------------------- Lining material------------------------------------- <br /> I-J- <br /> ...-_--.-.._______._ ._❑'- Size: Diameter ----------- -Depfh--------------------------- ------------Liquid Capacity----------------------------gall. <br /> Privy: Distance from nearest well----------------------------------------.........Distance from nearest building----------------------------- <br /> _------ <br /> . <br /> ❑ Distance to nearest lot line------------------------------------------------------------------------------ ------------------------------------------------------ <br /> Remodelingand/or repairing (describe):-------------------------------- ---------------------------------------•-- ---------------------------------------•---•------- ------------------------ <br /> -------------------------------------------------•------- --------------------------------------- <br /> - ------------------------------------------------------------------------------------ --------------------•----------------------------------------------------- ------------------------------------------ <br /> ------------------------------------- -----------------------------------------------------------------------------------------------------------------------•---------- --------------- ------------------------------ 4- , <br /> 6 <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 and regulations of the San Joaquin Local Health District. <br /> 7-7-io-j06- <br /> Si ned --- --- --------- ------------- ------------------------------------------------------- - -------(Owner and/or Contractor) <br /> I <br /> By:-----------------------------------------------------------------------------------------------------------------------------------(Title)--------- - - -------- --------------------- -- -------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> I <br /> FOR DEPARTM NT USE ONLY <br /> APPLICATION ACCEPTED BY--- 1� <br />