Laserfiche WebLink
APPLICATION FOR SANITATION PERMIT �'�'Permit No. <br /> i { (Complete in Duplicate) '� q <br /> Date Issued <br /> Applica}ion 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 /> JOB ADDRESS AND OCATiON------ ---- <br /> --•--- ••-------- <br /> Owner's Name----- -------•---- --------- - --:--- Phone----------------------------------- <br /> Address--------------------------------- '3f�' =� <br /> -•------------------ ------------------------------------------------------- <br /> Contractor's Name----------- ------------------------------------------------------.------------------------ Phone,_r._ �. <br /> - , <br /> Installation will serve: Residence R'partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _/_. Number of bedrooms-__ ___ <br /> Number of baths _/ Lot size ----��0-�-- ----�d-�------------------------•- <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water.Table _!�J.r_ ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay.Loam [] Clay ❑ Adobe [B- Hardpan p <br /> Previous Application Made: Yes ❑ No 02-New Construction: Yes [t]__1�0 ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> ( ose tic tankcesspool P permitted sewer <br /> le � 0 f_�.) <br /> Distance nearest well Septic Tank: -___--sanceromouna0Material_------------- <br /> 2-01, <br /> �'_l�y <br /> 2' No. of compartments--- ... <br /> .X-Sjo-------.---Liquid depth---- 1 ----------CapaciJty__ <br /> ,8 <br /> 'S <br /> Disposal Field: Distance from nearest well__ Distance from foundation___o?a.--------Distance to nearest lot line--------- <br /> Number <br /> ________NumberLength <br /> y- <br /> .__ <br /> _ <br /> r/Gf <br /> of lines_-_.__ _____S-__._ __. Len th of eacH line:__ A._'----------------Width of trench--- - <br /> 9 --------------------- <br /> Type of filter material.si.l _Depth of filter material_.__."------Total length____3_0- -------------_--- <br /> Seepage <br /> _Seepage PDistance to nearest well..?��__--_Distance from foundation_._. .`__-_..Distance to nearest lot line_-_e6�-_- _ <br /> Number of pits____/-------------Lining material_�0119AA Ckize: Diameter__._a_3....�____.Depth...... `___........ <br /> .- <br /> Cesspool: Distance from nearest well-------------_---Distance from foundation----------.---------Lining material------------------- 4r <br /> ❑ Size: Diameter--------------------------------------Depth---- ----------------•--- -- ---------------------Liquid Capacity-------------------:- gals. <br /> Privy: Distance from nearest well-----------------------------------_-------------Distance from nearest building-----------------------.-----------------. <br /> ❑ Distance to nearest lot line- ---- -------------------- --------------------------------------------- ------------------------------------------------------------- Z <br /> Remodeling and/or repairing (describe)--------------------------------------- -------------•-----•----=-----------------• I------------ -----•----------------•-•-------------..---------------- <br /> ---•------------------------------------ --------•-----------•-=---------I----------------------------------------------------------------------------- I--------------------------------------------------------------------- <br /> ! r <br /> - -------------•-•--------------------------------------- -------------- <br /> =---------------------------------------•--------•--` ;------------------•-•---•---:.....------------------•------------------------------•---•-- •--••---------------------- -------------------------- <br /> I' hereby certify that I have prepared this application and +hat the work will be done in accordance with San Joaquin County <br /> ordinances <br /> laws,-a rules and regulations of the San Joaquin Local Health District. <br /> (Signed ! { <br /> 9 ) '� ------ - - -(O er an, Contractor) <br /> By: a 1� ' -- .' `- 'C -----)Ti+le) - - -- ----- <br /> (Plot plan, showing size of lot, location`of system in rela on to wells, buildings, etc., can be placed on reverse side). <br /> ° FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------------ �= ------------------ --•-------------------------------I----- DATE-------- <br /> REVIEWED BY--------------------- --------- DATE I'J 14 <br /> BUILDING PERMIT ISSUED---------------------0-- ----- ---------------------------------------------------------------------- DATE- <br /> Alterations and/or recommendations----------------------------------- ------------ -----•-•------•-----------•----------•• --------------------------_----------------------*------------------ <br /> -------------------------------------•----------------•------------ -------- ------------ -------------------------------------------------------•..-•---•-------------•------------ ------------------------------------­_ <br /> ---------------------------------•------------•----------- ------------------------ ------------------------- -------------------------------------...---------•-------.---------- ------------------•--•--------- <br /> -------------------------------------------------- •---------------------------- ------- ----------------- --------------------------- •---------------------------- ---------------•--•----- -- <br /> e. ,, <br /> FINAL INSPECTION BY:.------ •--- •---If _ --------------- Date-----y <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M 145446 ATWnUD 12.54 <br />