Laserfiche WebLink
P"I `0-' APPLICATION FOR SANITATION PERMIT Permit No. ` � -.... <br /> Z � (Complete in Duplicate) <br /> Date Issued _.x_..11..,._... <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 AND LOCATION------ � <br /> Owner's Name---------�.�-------- ----- -- ------• ------- -- -e - Phone-------- .......................... <br /> 1 . <br /> Address------- - - ------------• - 1 <br /> Contractor's Name............... •-------•------ ----------------------------------------------------------------------------------------------- ------ Phone----------------------------------- <br /> Installation will serve: Residence'[X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ._ _.. Number of bedrooms ----[ Number, of baths -----/ Lot size .... _.X_L.07 .................... <br /> Water Supply: Public system Community system W Private ❑ Depth to Water Table ........ ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay Adobe❑ Hardpan ❑ <br /> Previous Application Made: Yes ❑ NOX New Construction: Yes X No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if piolic sReis available within 200 feet.) <br /> Sep i Tank: Distance from nearest well_ L /_ ance fro oundation..__._f. ...,_.Materi _..___._._.................. d _-No. of comp'artments--------�Y..:. ... ze..4-r_� X.�Liquid depth._.._......_....-.._..._Capacity._._L�_-__..... <br /> Dispo I Field: Distance from nearest well.41l0__.Distance from foundation....1-_Q_--------Distance to nearest lot I- �J <br /> �-- ----- <br /> Number of lines...... .. Length of each line----4.L?___.__t�,----Width of #rench....jZ .... .................. <br /> Type of filter material.__ [Depth of filter materiaL...._ _g____....Total length-..-------------- a.............. <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line................. <br /> ❑ Number of pits----------------------Lining material-----------------------Size: Diameter------------------ ----Depth--------------------------------- %A <br /> Cesspool: Distance from nearest well-----------------Distance from foundation---.----------------Lining material-------------------------------------- <br /> Size: <br /> _....--.._.._.._.._,_.._-- ____-.Size: Diameter----------------- --- _De th-..---.-------------------------- ------- ----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 /> NOW <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <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 /> (Signed)------. ...... -- --------- ---------------------------------------------- ------------------(Owner and/or Contractor) <br /> --------------- <br /> By:.---- <br /> L-6-1 <br /> -----------------(Title)---------- <br /> (Plot plan, showing size Q lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). �} <br /> FOR DEPARTMENT USE ONLY 0 <br /> APPLICATION ACCEPTED BY------------- ------------------------------- ---------------------------•---_----===------ DATE-- `. <br /> REVIEWED BY_-. - ------------- ---- ---- ------- -- ---------------------------- DATE-- .rye' <br /> 514 <br /> BUILDINGPERMIT ISSUED----------------------------------------- -_.. . .-- �,-•---•--••------- DATE....................------ -- <br /> Alterationsand/or recommendations----------------------- ----------------------------------------------------•----------------------------••---------•---------....-----....................... <br /> ---------------------------------........--------------------------------------------------------------------------------------------------------------...._....----------------------------------------------------------- <br /> ----•----------------- ---------------------------------•--------------------------------------------------------------------------------------------------------------- ----------------------------------------------------- <br /> ............... ....................................................... --- --- . ------- ---------------•----------------------------------------------------------------------------------------------------------- <br /> ------ ------------- Date----------- ..-- --------------------- <br /> FINAL INSPECTION BY:.-------------------•-- -----.-.--__-- - �--/-------- - - - <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 10-52 Revised W-2100 <br />