Laserfiche WebLink
FO OFFICE USE: <br /> . . .� <br /> ----__-----------------------..._._-.____.---__ APPLICATION FOR SANITATION PERMIT Permit No. . <br /> - -------------------------------------------------•---- (Complete in Duplicate) <br /> ------------ <br /> This Hermit Expires i Year From Date Issued Date Issued <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.__ 49Q__.-- i'P �.1!._.._.___`_ f1"- C'f[. a/ ! <br /> ------------- <br /> Owner's Name------- ------..Af/ /17/ -----------------------------------------------------••-•- <br /> --------------- <br /> Address ----------------- <br /> -••------------------------------------------------------------------ <br /> ---_-._------•-----------------------•-------------------------•------------------.---- <br /> Contractor's Name--- ---------------------•--•---•------------------------------------------------------------------------------------ Phone...---•---........................ <br /> Installation will serve: Residence Q( Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units. -/--- Number of bedrooms .Z. Number of baths .I... Lot size __--__ .�. ........................... <br /> Water Supply: Public system ❑ Community system ❑ Private R1 Depth To Water Table __ ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel#❑ Sandy Loam S� Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date--------------------) No 54 New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (I o septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Sel/X+ Distance from nearest well----------------FDistance from foundation--------------------Material ________._.___.______--_----------__._________-. <br /> No. of compartments-------------------------•Size•--•------•-•---•---------------Liquid depth._......-..---------------Capacity----------------------- <br /> Disposal Field: Distance from nearest well--- _�._Distance from foundation---/Q-__.......Distance to nearest lot line-_......... <br /> 4jpj ❑ Number of lines---------/------------------------Length of each line-------EIC2______________Width of trench____1 l.__ <br /> Type of filter material. ij Q <br /> �:��_.___.__Depth 1�_ ----------Total length----------- _ <br /> Seepage Pit: Distance to nearest well______________________Distancof filter material_.__ <br /> e from foundation....................Distance to nearest lot line_______._______-_ <br /> ❑ Number of pits-----------------------Lining material-'--------------------Size: Diameter-----------------------Depth----_-_--.--.-------------------- Q <br /> Cesspool: Distance from nearest we€l_________________Distance from foundation-------------------.Lining material--__-_-____-_______-______________-_ <br /> ❑ Size: Diameter-- Depth .',..i--------------------•----------------------._Liquid Capacity--------—-----------------gals. <br /> Privy: Distance from nearest well------_--------------------_-------_-----_-------Distance from nearest building-----------..-__-_--._________.__.._-__--- <br /> ❑ Distance to nearest lot line-----------------------I----------------------------------•-- <br /> Remodeling and/or repairing des ri eI: y :.. <br /> --------------------------------•-------------- - - --------=:fQ-..•_ ®v - -s <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 /> 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 /> R DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED __ _______ ------------------ DATE--- <br /> REVIEWEDBY------------------------------------------------------------------------------------------------------------------------------ DATE-------------------------------------------------------- <br /> BUILDINGPERMIT ISSUED......--•-----------------------------------------------------_-------------------------------------- DATE------------------------------------------------------------- <br /> Alterations and/or recommendations:-------------------------------- ----- ---- - -- -----------------------..------------------------------------------------------------- ---.------------ <br /> ---------------•-------•--•-----,-•--------------------------------•--------------•--------------------•---•-------------------------------------------- .....................------------------------------------------ <br /> --------------------------------------------- <br /> FINAL INSPECTION BY:. _.. .. ----------------------------- Date---- 11--4 -�.�.----- - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Sireet 124 Sycamore Street 205 West 91h Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> E5 9 REVISED a-59 EM 5-62 ATLAS <br />