Laserfiche WebLink
APPLICATION FOR SANITATION PERMIT Permit No. .I-.*3. <br /> �1 <br /> .... ..... <br /> (Complete in Duplicate) Date Issued <br /> Applica-lion is hereby made to the San Joaquin Local Health District for a permit to construct and install the wor4 hereip described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION------- <br /> ----------------------­---- <br /> 0 <br /> Nae--------------.......... - ---------- -------- --------- -------------------------------------- Phone ---------- <br /> ro 4 a--e? <br /> c1dress......(---------------rz-----------3_3__l <br /> -------------------------------- <br /> Contractor's Name----------------- -----------------Apartment <br /> --------------------------------------------------------- Phone----- ----------------------------- <br /> Installation will serve: Residence 2ee--Arartment House Ej Commercial [] Trailer Court E] Motel 0 Other E] <br /> Number of living units: Number of bedrooms -5-- Number of baths q!7�_ Lot size ------------------------- <br /> Water Supply: Public system E] Community system C-] Private 2-15epfl-i to W ter TabA-,q-" ft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel L] Sandy Loam ;;�7oam E] Clay [] Adobe El Hardpan [j <br /> Previous Application Made: Yes [] No 2-- New Construction: Yes 9—No E] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic-Tank- — -Disfance-from.,nearesell- ---_Distance-from fouodaf ion--/0... <br /> t-w ....... _Material-----clld`_�__ ---- -------------------- <br /> PC No. of compartments-----.;Zrn�:----------- Size_/_.�_ y <br /> Liquid dep' ----------------Capacity_, -Ir__ <br /> Disposal FieId: Distance from nearest D+stance from founclaflon__A�5�0? _.....Distance to nearest lot line---- <br /> Number Length of each line__-.75-—--------------Width of french---- <br /> �.-_j&A <br /> Type of fiJter me I I --Depth of filter materi.�------ ` ___-_.Total length___ -------- <br /> Seepage'Pif: Distance to 'nearest well------- ---- ------r-Distance from foundation--------------------Distance to nearest lot line----------------- <br /> El Number of pits----------------------Lining material-----------------------Size: Diameter_.•------------------Depfk.-- ------------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--- ----------------Lining material-_.__-...-------_--------____--_------ <br /> Size: Diameter----------------------- --------------De ------------- - ,.�quid Capacity ----gals. <br /> Privy. Distance from nearest well-------------------------------------------------Distance from nearest building----------------- ------------------------ <br /> ❑ <br /> uilding------------------------------------------ <br /> ElDistance to nearest lot line----------------------------------- ---------------------------------------------------------------------------- <br /> Remodelingand/or repairing (describe):-------------------- ------------------------------------------------------------------------------------------------------------------------------------ <br /> --------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> -------------------------------------- ------------------------------------------ -------------- --------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------- --------------------------------------------------------------------------I---------------------------------------------------------------------------------------------------------- <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, Stat and rules and re lations of I San Joaquin Local Health District. <br /> (Signed) — 7 1 <br /> Ir <br /> -- ------ - ---- - --- ------------- ----------------------- ------- -------------------------(Owner and/or Contractor) z. <br /> ------ ...... ;-,e <br /> By:__------------------------------------------------------------ -----------------------------------------------------------------(Title)--------------- -------------------------------- -------------- <br /> (Plot plan, showing size of lo+, location of system in relation 4o wells, buildings, etc., can be placed on reverse side). <br /> TME <br /> VT USE 9LY <br /> APPLICATION ACCEPTED BY.. --- DATE...... <br /> ---------------------- <br /> REVIEWEDBY---- ---------------------------------------- ---------------------------------------- -------------------------------------.. DATE------------------- <br /> BUILDING PERMIT ISSUED------------- ------------ --------------------------------------------------------------------------- DATE <br /> Alterations and/or recommendations:----------------------------------------------- ---------- --------------------------------------- •------•-----------•- -------------------------------- <br /> ---------------------------------------- ----------------------------- -------_---------------------------------------------------------------------------------------­--------­----------­-- -------------------------- <br /> ------------------------- --------------------------------------------- ----- ------------------------------------------------------- ----------------------------------- --------------------------------­-------------- <br /> -------------------------------------------------------_-----------_;----------------------- ------- ----------------- --------------- --------- ---------------------------------------------------------------- A <br /> --------------------- ----------------- ------ ----------------- ------ -------------------------- --------------------------- -------- ------------------------------------------------------------------------ <br /> FINAL INSPECTION BY.-_.,_ Date-----------; X ---------------1 ------------------- <br /> ---------------------------- <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 /> 145446 A7W30D 12-54 <br />