Laserfiche WebLink
FOR OFFICE USE: x <br /> APPLICATION FOR SANITATION PERMIT <br /> Permit No. ._.l_ __ ..... <br />------------------------- ------------------------------ (Complete in Duplicate) <br /> Date Issued <br /> __________________ This Permit Expires 'l Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a Permit to construct and install th work herein described. <br /> This application is made in compliance.-..'with County Ordinance No. 549. rc.. . <br /> JOB ADDRESS AND LOCATI N----- - -------------------- ----• = ��. ter ._.. = !'" ```` �' <br /> , <br /> Owner's Name----------------.. ----------------------------------V ���­A-'-�-`-`tom---------- -- - ---------- -------------- Phone----------------- <br /> ------------------------------------ s <br /> Address------------------------•--- ------------------------- ------------------— ---•- <br /> � Phone.....Contractor's Name----------------------------------- ---. ... -• ------------ <br /> Installation <br /> ------ •- <br /> Installation I <br /> will serve: Residence ��partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ 1 <br /> Number of living units: __/_ --- Number of bedrooms --3-. Number of baths _Y Lot size ............ ....-----............. � ----------- <br /> Water Supply: Public system El Community system ❑ Private ® Depth To Water Table --Z_. ft. <br /> Character of soil to a depth of 3 feet:I Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ (� <br /> Previous Application Made: (1f yes,date--------------------) No 9--_—New Construction: Yes Ej--Pd-o ❑ FHA/VA: Yes (] No Q_ i <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: Ji <br /> (No septic tank or cesspool permitted if publi6 sewer is available within 200 feet.) <br /> Septic Tank- Distance from nearest well from foundatio -_--- Material---__ tyNo� of ets______________ X_r>✓Liquid de th______.__..y_______._CapacspI _ � <br /> Disposal Field: Distance from nearest well-_-,.r=._�:_._Distance from foundation______ _p--_Distance to nearest lot line........:........ <br /> �Num!?er of lines___."-_____... 3_.____. ____Length of each line___________�f r'_.......Width of trench________________ ._ <br /> Type of filte 'material_.. �1 .Depth of filter material______ _".__.Total length___....___ ---- <br /> Seepage Pit: ` Distance to nearestwell----------------------Distance from foundation--------.-----------Distance to nearest lot line----------------- <br /> 171 Number of_pits_______ _____________Lining material--------------------1_-Size: Diameter-----------------------Depth-----------__--------....___ <br /> I <br /> Cesspool: Distance from nearest well--_--___•.---_-.LDistance from foundation--------------------Lining material------------------------------------- <br /> ❑ Size: Diameter---------I----------------------------Depth--------------------- I------- ---------------------Liquid Capacity --------------------------gals. <br /> , I l <br /> f Privy: Distance from nearest well------------------I------------------------------Distance from nearest building----------------------------------------_. <br /> ❑ Distance to nearest lot line------------------t-------------------------- -------------------------------------•--------•-----•--------•-----•----------------------- <br /> t <br /> Remodeling and/or repairing (clescrib ):---' = -A----------------------------------------------- -------------------------------- <br /> ' ------------------_5_t___ _______________________±'______._._____________.-____..___________.__________._._._________.__..-.._._-____________...__.------------------------------- �•y <br /> M* <br /> --------------------------------------------------------------- ------------ -- -------------------------------------------------------------•_-_____-___---__----.__.-------__----_---_-----_-------.-_-.___-.-_-_._- <br /> l _______________------------------------- -------- ----------------------- <br /> _ ___ _ _______________ <br /> I hereby certify that I have re `ared'this applications nd 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 /> (Signed)- -------- ----------- -------- 4 --------------- <br /> -------------------- <br /> ------------- (Owner end/or Contractor <br /> BY• ------------------- (Title)---------------------•----------------------- --- <br /> By—,e5 <br /> - <br /> (Piot plan, showing size of lot,location'of system in relation torells, buildings, etc., can be placed on reverse side]. <br /> DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---------- -'_- - -- ------------------••------ DATE __... :! _--- --------.. <br /> REVIEWEDBY----------------------•---------------------------------- :------------------------------------------- DATE---------------------------- -----------••----------------- <br /> BUILDINGPERMIT ISSUED-------•------•--------------------------------------------------------------------------------------- DATE------------------------------------------------------------- <br /> AFteratio sand/ recommendations: - ; firms; -------- .�,-} S cam <br /> 5 - ': .f -��-------------�-- ------ ---- ------------- ``-`�' -------_---- <br /> • •----•------------------------------------------•--•-..-.--•-----------------------------------•--------------------•----•------------------------•-------..----- <br /> -------•--•------------------ ---------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> i � -,-< <br /> ?. - --- -- ----- ----------------------------- <br /> -0- ----..`�_��:_�- --- <br /> FINAL INSPECTION BY--------------- - ---• --- - -e---- --------- --- <br /> ---------- Date---- <br /> 14 SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak tirsit 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REWSED 5-59 2M 5-62 ATLAS <br />