Laserfiche WebLink
APPLICATION FOR SANITATION PERMIT Permit No<:;;7�6____�_Y <br /> J _ U Z (Complete in Duplicate) ,6 <br /> Date Issued /�7.7../ ^ Y <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 /> JOB ADDRESS D LSO TION---1 <br /> Owner's Na a---- -- ------•-- --------- --------- ----- ------ Phone = <br /> Address ' Q <br /> Contractor's Name--- ----•----------- - --- ----- ---------------------------------•-------------------------------------------=----------------------- Phone----------------------------------- <br /> Installation will serve: Residences V Apartment House ❑ Commercial ❑ Trailer Court ❑ Mp�el ❑ Oth9r ❑ <br /> F Number of living units: ____I--- umber of bedrooms -]--- Number of baths _-L_ Lot size _ _le._____________________________ <br /> Water Supply: Public system Community system Private Depth to Water Table -------- ft. <br /> Y Y ❑ ❑ p <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam El Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> Previous Application Made: Yes [] No [( New Construction: Yes ® No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: Q <br /> (No septic tank or cesspool permitted ' public s er is available within 200 feet.) <br /> Septic ank: Distance from nearest well____ �ista cpa fro Ifo ation__� <br /> { <br /> No. of compartments------ -------- ------- Siz -�_T_X ----Liquid depth---------a�_-----------Capacity-.-- _ - -- <br /> Dispos 'I Field: Distance from nearest well . istance from foundation-_-_ _ __ _-I__ Distance to nearest to lin .f��__.... <br /> +[ Number of lines ------ <br /> __---__ _ Length of each line-------------- Y Width of trenchll <br /> 4- <br /> 41'I , D f f <br /> Type of filter materia_ ___ .__r •epth of filter material_________ ___. length len th_______-- _ <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation---------------------Distance to nearest lot line________________ <br /> ❑ Number of pits----------------------Lining material----------------------.Size: Diameter---------------------- Depth--------------------------------- <br /> Cesspool: Distance.from nearest well_________________Distance from foundation-------------------.Lining material-----------------..------------_•____- <br /> ..De th___ -___---_-_ :�___:_.:__ . ' Li uidTCa acit -_ .�ga <br /> [] Size: Diameter-------------------------------------- p ---- q P Y •....... ga s. <br /> Privy: Distance from nearest well--------------------------------------------------Distance from nearest building__-._--________--___-_-_________--.__.-_. <br /> ❑ Distance to nearest lot line----------------------------------------------------------------- <br /> Remodeling and/or repairing {describe):------------------------------------------------------- ---------------------------•-•-------------------------------------------- <br /> ------•-----------------------------------------------------------•---------...--------------------------.----------•----•---------------------------------------•----------------------------------------•---------------- <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 /> E <br /> (Signed) - ---------------------------------------------------------------------------------------(Owner and/or Contractor) <br /> By:--- ----------------------- -------------------I----------------------------------------------------------------------(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 /> APPLICATION ACCEPTED BY - ----------------------------------- ------------------------------------------- DATE-r" <br /> REVIEWED BY---------------------------------- <br /> ------ DATE - X <br /> BUILDINGPERMIT ISSUED------------------------------------------------------- ---------------------------------------- DATE----- - - - <br /> ------------- - <br /> Alterationsand/or recommendations:---------------------------------- --------------------------------------------------------------------------------------------------------------------------- <br /> •----------------------------------------•---------------------------- ---------------------------------------- <br /> --------------------------------------------- -------------------- <br /> FINAL INSPECTION BY':-------------- <br /> - -------- Date----------� UV - <br /> r x 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 8-51 Revised W-2100 <br />