Laserfiche WebLink
1b�11,,p( APPLICATION FOR SANITATION PERMIT Permit No. .___uQ_V_.. <br /> ( ' (Complete in Duplicate) <br /> �yDate Issued ._____�1Z—__ <br /> 4Arplical-ion is hereby.made to the San Joaquin 'Local Health District for a permit to construct and install the work herein described. <br /> Thiss application is made in compliance with County Ordinance No. 5491.. <br /> JOB ADDRESS AND Ll; SgATION--F----------------------------------------' ,3_�...--. ./--------------•--•--••--------------- - <br /> Owner's Name-------------=- � -----•------- G' ---=--------------------•--- ---------..----------------- Phone----- ------------------------------ <br /> Address �' --' - - •---•--------------------------------------------------- <br /> t , <br /> Contractor's. Name----------------------------------------- ------ d t/ ---------------------------•------------------------------------- Phone.---------------------------------- <br /> Installation will serve: SResidence Apartment House E] Commercial -E] Trailer Court C] Motel ❑ Other ❑ <br /> Number of living units: _------; Number of bedrooms 3_-_ Number of baths -------- Lot size --------- --- ,-____________________________ i <br /> Water Supply: Public`system K,''Community system ❑ Private ❑ Depth to Water Table________ ft. # <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay 1Ul Adobe, Hardpan ❑ <br /> Previous Application Made: Yes ❑ No W New Construction:.Yes ❑ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 fee+.) <br /> Se pticTank: Dis+ante from nearest well_- Distanc �om foundation---AQ________._.Mat efiI_______ <br /> No. of compartments_____... ®'___.____._5ize__' � 9___Liquid depth_.____ _` __.______;Capacity_____/� ___ <br /> Dispos I Field: ?Distance from nearest well__ Distance from foundation_____.f ......Distance to nearest lot Gne_____'.2­4 -�... <br /> Number of lines________ ------ ____._Length of each line--------------_-�+._-iP--------.Width of french.______._.__ ~ -��________ <br /> Type of filter material_ __ _____ ____ epth-of filter materiial___.______jf_____ Tial length_�____________-__IeO—________-- p . <br /> " ,� T 4� <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 /> { <br /> t <br /> ❑ <br /> i -___.-___._____ _:Lining_maeraCesspool: Distance from nearest well_____________----Distance-from foundation <br /> '- -= g'_' <br /> ~ `Size: Diarnet—&-_--_ - _ r_;De h__yam Li uid Capacity <br /> ---- -- _ __________ __----- --------- : -- al's__ <br /> . <br /> Privy: Distance from nearest well_________________________r----------------------Distance from nearest building___________________--______________._.__ <br /> ❑ 'Distance to nearest lot line------ = - -- <br /> -------- -----------•----------------------- -•----------- <br /> RemoJeling and/or repairing (describe)------------- - <br /> -------•-•----------------------------------• l <br /> _________.____________________________.____________________.._________-__________________-._-__-___•___-___-_____________________________.__....__._____________________________._________».._____._________-___.____-______- <br /> ________ <br /> hereby certify that I have-prepared this application and +hat the work will be done in accordance with San Joaquin County <br /> -4 State laws, and rules .and regulations of the San Joaquin Local Health District,, <br /> (Signed)___A ;�----:Z", --------- ------------------ -----Owner and/or. Contractor <br /> x <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 /> d 6 <br /> ]:. FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--------- ----- --------------=------------------------------------------- DATE--------- �' <br /> REVIEWED BY-----------I--------------------- --------------- <br /> BUILDING <br /> b <br /> - �- -------------------------- -----------------. DATE-- -------------- = <br /> -----••-------- <br /> BUILDING PERMIT ISSUED------------------ --- --- --- --------------r--------------•--=- - ----------- DATE--------------------- <br /> Alterations and/or,recommendations:---------- <br /> - ~~�- - <br /> ----------------- <br /> ------------------------------------------------------ <br /> ------ -' ,a <br /> -------------------=--------------- --- - ------------ <br /> r - - <br /> FINAL"INSPECTION BY:---------- '.Y.----- - hp.­l--------------------------------- <br /> r <br /> -�/ = <br /> ---- Date..------•-�- <br /> � SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Streef <br /> Stockton, California Lodi, California Manteca, California Tracy, California j <br /> ., ES-9-2M Revised W-2100 t <br />