Laserfiche WebLink
APPLICATION FOR SANITATION PERMIT P mit No. -• ''-- <br /> �1� (Complete in Duplicate) ,�.. <br /> Date Issued - <br /> ------------ <br /> pplication 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. SO Z417e'-s"�_�,4061 <br /> JOB ADDRESS ANLOCATION__� 'T /-L;�� !9�---------04----------------- '' <br /> Phone------------------------ -------- <br /> Owner's Name--- ------ R ------------------------------------------------------------------------------- <br /> -------- ---------- ------ •-- � - �L--.----------------------------------------------------- <br /> ------------• -- -------- <br /> -Address <br /> Contractor's Name_____ ------ • ------------- Phone--�' <br /> Installation <br /> will serve:..Residence 0--`X`rartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: .-{-- Number of bedrooms _2_Number of baths )----- Lot size?_=__4.0--- -- I-- -C?__----__________.___ <br /> Water Supply: Public system 5' Community system ❑ Private'❑ Depth to Water Tableft. <br /> Character of soil to a depth of 3 feet: Sand F] Gravel ❑ Sandy Loam ❑ Clay Loam Dg, Clay E] Adobe E] Hardpan [] ` <br /> Previous Application Made: Yes ❑ NoM-, New Construction: Yes`4 No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> "(No-seplfic.tank o""rY�esspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well___" Distance from foundation__.fP__.._____-Material <br /> ti <br /> No. of compartments_.___...___-----_-_-Size.J_�__'?_X_,�`"___-___Liquid depth-_-fe............. -----______--_. —j <br /> Disposal Field: Distance from nearest well .7�.-Distance from foundation____1.41 . Distance to nearest lot line-_j--------- <br /> Number of lines------------- - -Length of each line--------- r Width of trench.--- -___.._____________ . <br /> Type of filter material----1_._�� _1___4___1__3e'__Depth of filter material--------1$__..........Total length-------.8_-'_____._ <br /> Seepage Pit: Distance to nearest well... -- _Distance from foundation___ Distance to nearest lot line___(�---------- I <br /> Number of pits-----I-------------- material__&­A.1_--_.Size: Diameter_____1�8_...r-___.Depth__--.1A-.................... <br /> Cesspool: Distance from nearest well_________________Distance from foundation------------------- Lining material-------___-_-________.____.______- <br /> [] Size: Diameter--------------------------------------Depth--------------------- -----------------------------Liquid Capacity- --------------------------gals. <br /> _______ _______________________ <br /> l Privy: � , Distance from nearest well---_------________________________.._.-- -Distance from nearest building_______ <br /> _-_-- - <br /> ❑ Distance'to nearest lot line-----------------------------------------------•---------------------- --------------------------------------------- --- ------ -- --------- <br /> Remodeling and/or repairing (describe):__ -------I----------•-----•-------- i <br /> -----------•--•------------------•---•-------------------------------------------------- ---------------------`----------------------------------------------------------------------------------------------------- <br /> -------------------------- ---------------------------------------•---------------------------------------------------------------------------------------------------------------------------------------------------------- I <br /> - - -------------------- ----------------------------------------------------------------••----------------------------------------------- ----------------------------•----- --------------------- ------ <br /> k I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> I ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> L ! <br /> ----.______. ' r Contractor <br /> (Signed)--- - -//�- -- •- ------ --• -- ------------------- ---------- --�------�------•'------- ------------------- { �' ) <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 /> FOR DEPARTMENT USE ONLY <br /> r <br /> APPLICATION ACCEPTED BY DATE <br /> ------------- ".."------------------------------------------ <br /> ------------------------------------ DATE------------- -----••-- .------------------------------ <br /> REVIEWEDBY--------------------------------;---- - - --- ----------------------------------- <br /> BUILDINGPERMIT ISSUED----------------- --------------------------------------------------------------------------------- DATE------------------------------------------------------------- <br /> Alterationsand/or recommendations:----------------- --------------------------------------•------------------------------------------ -----------------------•---------------•-•----------- <br /> •--------------------------------------------------------- ---------------------------------------- -------------------------------------------------------------------------------------------------------------------- <br /> a <br /> ---------------------- <br /> FINAL INSPECTION BY-------------- 1 -------------- Date---------- 1. ---- 4 <br /> - ---------------------------------------- <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 io-52 Revised W-2100 <br /> • s� <br />