Laserfiche WebLink
APPLICATION FOR SANITATION PERMIT Permit Neal. <br /> (Complete in Duplicate) <br /> Date Issued ----- ----- <br /> Irlion is hereby made to the San Joaquin Local Health District fot:.a_Pprmif to construct and install the work �erein Tes—crfie? <br /> T P's caf application is made in compliance with County Ordinance No. S492 0 <br /> JOB ADDRESS AND LOCA E----C,,� <br /> 1 N--------------- --- - -------------- <br /> 'PA -------- ....0------!-------- --- --- - --- ------ ------------- --------- ---- -- ----------------- <br /> --- ----------- --- -- --------- ------- --------------..L---- <br /> Owner's Name. .... .. ------- <br /> .............. <br /> ------------------- -----------------*---,-*-------------------- <br /> Address- <br /> Contractor's Name-------- A------- ......... .... ------- ---------------------------------------------------------------------------------- Phone--.,, � <br /> Installation will serve: Residence [_1 Apartment House Commercial 0 Trailer Court El Motel E] Other <br /> XNumber of living units/ Number of bedrooms *n14__ Number of baths 0'^4- Lot size ----7.�!�---------7J-_------------------------ <br /> Water Supply: Public system 2--Community system 0 Private Ej Depth to Wafer Table yd__ ft. <br /> Character of soil to a depth of 3 feet: Sand (—] Gravel E] Sandy Lo Clay Loam Ej Clay E-] Adobe 8'-'Hardpan <br /> Previous Application' Made: Yes F1 No 2�' New Construction: Yes ;o No 11 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Distance from nearest well - ---D' t From foundation---/10----------Matprial--- <br /> Septic Tank: --- -------- <br /> ----- is anc� <br /> No. of compartments .•552 ......... ......­-------------- Liquid depth---------- ---- -------- capacity----l <br /> Disposa: Distance from nearest well..............— ---Distance from foundation__- -------Distance to nearest t line____-_____--- <br /> Dispos�._ >� Or� <br /> Number of lines-_---•-------- --Length of each line---------qF0-------------Width of trench--- <br /> Type of filter mate Dept h of filter material ----Total length_______ ___I <br /> Seepag Pit: Distance to nearest well-----—---------Distance frorri__�oundation-----%-3-4-- -----Distance to nearest lot line---' <br /> Number of pits---------/--------------Lin-,ing materialit---- <br /> Diameter------C.-Jr... Depth- <br /> Cesspool: Distance from nearest well----------------Distance Distance from foundation----- --------------Lining material________..______....____._._-----__._ <br /> El <br /> Size: Diameter------------------ -------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building__--______.__.__------------- -------- <br /> ElDistance to nearest lot line-------------------------------------------------------------------------------------------------------------------------------------------- - <br /> Remodeling and/or repairing (describe):------------------------------------------------------------------------___------------------------------------------------------------------------ <br /> ------------------------------------------------------------------ ----------------------------------------------------------------------------------------------- --------------------------------------------------- <br /> --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Count <br /> ordinances, Stat laws, and ruAl and regulations of the San Joaquin Local Health District. <br /> (Signed)-. --- ---- CO3',_q1----------------------------------------------- wr and/or Contractor <br /> ,011�-------------------------------------------------- <br /> By:.-•--------------lam_ -------------- P.---------- <br /> ---------------(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 /> Contractor <br /> APPLICATION ACCEPTED BY_ ----- ----------------------------------------------------------------------------------- DATE-Rj\ <br /> ------------------------------------------------ <br /> REVIEWEDBY---------------------------------- ---- ---------------------------------- ------------- --------------------------------- DATE--- -------------------------------------------- <br /> BUILDING PERMIT ISSUED----- -------------------------------------------------------------------------- DATE---------L IN---------- --------------------------------- - <br /> Alterations and/or recommendations:-------------------------------------------------------- --------------------------------------------------U.------------------------------------------- <br /> ---------------------------------------------------------------------------------------------------- ---------- ----------------------------------------------------------------------------------­-----------------f <br /> -----------------------------------------------------I------------------------------------------------------------------------------------------------------------------------------------------------------------ --------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------- <br /> ------------------------------------------------------------------------------- - --- ------------------------------------------------------------------------ -------------------------------------------------------------- <br /> S_ AT <br /> FINAL INSPECTION BY:------ ------------ Date------ / -/ <br /> 3 <br /> - -- --- --------------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 30D West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> E5-9-2M 10-52 Re,,ised W-2100 <br />