|
APPLICATION FORSANITATION SANITATION PERMIT Permit No. .... _
<br /> (Complete in Duplicate)
<br /> ' J } Date Issued"" . ..��
<br /> ,Application is hereby made to the San Joaquin Local Health District for a permit to construct and stall he work herein described,
<br /> This application is madJ�eyiynjgccmplian ith County Ordinance No. 549,
<br /> JOB ADDRESS AN LOCATION
<br /> Owners Name...
<br /> 7
<br /> Address............... j.... .��,...... »_.».,....».....»»..»_... ..ae._.` .. .... .................
<br /> Contractor's Name....... _ .............. Phone.. .._.._.,._.
<br /> Installation will serve: Residence Apartment House Q Commercial E] Trailer Court I] Motel ❑ Other . .
<br /> Number of living units: __... Number of bedrooms Number of baths ........ Lot size ... ..rJ'.
<br /> Water Supply: Public system M Community system ❑ Private 1 Depth to Water Table -1-. - ft•
<br /> Character of sail to a depth ' fee': Sand Q Gravel [� Sandy Loam D 'Clay Loam F1 !Clay F1 Adobe F1 Hardpan ❑
<br /> Previous Application Made: Yes ❑ .No V New Construction: Yes j� No ❑ ' "
<br /> TYPE OF INSTALLATION AND SPECIFICATIONS: 10
<br /> (No septic tank or cesspool permitted if,public��s,e�we�r' vatlable within 200 feet}
<br /> Septic,Ta istance from nearest we=f.3r.t.1_r ce+from foundaaion.... #v'ate3ial ... . ....... .... p�•�
<br /> W
<br /> No, of compartments., ...... _._. Size....... .....-Liquid Liquid depth...._.._...... Capacity (n1
<br /> Msllosal Field: Distance from nearest wel2"'191-.10istance from foundation..... Distance to nearest lot line.;zz. e
<br /> .�
<br /> r
<br /> Number o? lines....�.._...._. ._ Length of each line.-...�..'r�.c_� _... . id#h of trenCl7.._�.,�
<br /> Type of filter materia{.J J,_ -Depth of filter material....,,
<br /> Seepage Pit: Distance to nearest well—__Distance from foundat:on....................Distanco to nearest Int line---
<br /> _..„»,,...
<br /> ❑ Number of pits.... .................Lining material.-,, ..........Size: Diometar........._.»»„._...Depth........._».
<br /> Cesspool: Distance from nearest well. ..............Distance from foundation....:...............Lining material............-_...........
<br /> ❑ Size: Diameter.....y._............ .. . ., -- ..... ..........._..... ........ »........
<br /> _........._Deph Liquid Capacity......_ .. . ..._ gals;
<br /> Distance from rearest well. �. .. _. Distance from nearest building
<br /> g V ��
<br /> . .........
<br /> Distance to nearest lot ;ine............'
<br /> , t
<br /> Remodeling enc'/or rep 'ring ( scriSe):.. ...... .._.. !Qrl���"�+X../ � ..
<br /> ................. ...... ................ ».»,............,.
<br /> _..-._........._...................._.._........_--------...................._._._..._.....-........ .. ... ..... .._. ._.._..
<br /> ............................ . . .... ...
<br /> I hereby certify that 1 have prepared this application and that.the work will be.d.one_ ..in accordance.. ..with San Joaquin C,ounty.
<br /> ordinances, State laws, and rules and regulations of the San Joaquin local Health District,
<br /> (Signed)..... �....
<br /> {Plot plan, showing size *f K, loca}ion of syzie'm in relation to walls, buildings, etc., can be placed on reverse side).
<br /> r FOR DEPARTMENT USE ONLY
<br /> APPLICATION ACCEPTED BY.................. .. _,...»..»»_......»... C7ATE. ~
<br /> REVIEWED BY.. .... DATE. ...... ........ . _»....»».»....
<br /> BUILDING ................ ........... ,,Y• .<.•- .,..,... ...
<br /> PERMIT ISSUED.'.................. �......
<br /> Alterations and/or r4
<br /> ...............................»....,.—I-1-1-1, DATE........__..._._....... _»....»..
<br /> recommendations:........rr3 me nd ati ons:............».....................
<br /> FINAL INSPECT! N � /!' ........,.,... .fi,.,...».»»»_.»�---.`•-
<br /> ..........
<br /> ».».,_......
<br /> lJ _
<br /> © BY...._...._.... . ............... .... . Da e.............. .
<br /> ( SAN JOAQUIN LOCAL HEALTH DISTRICT
<br /> 130 South American Street 1 300 W*%+ Oak S+raat 332 Sycamore Stria+ $14 North "C” S+raat
<br /> Stockton, California Lodi, California Manteca, California Tracy, California
<br /> tS-4-2M 0 z,2 Ravised W,2100
<br />
|