Laserfiche WebLink
A?ftAPPLICATION FOR SANITATION PERMIT. Permit No . <br /> I (Complete in Duplicate) <br /> �- Date Issued <br /> t <br /> Applical-ion 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___-____�_`-.�-�----_ t_______ <br /> Owner's Name----.,T.�'-- -.._ .__ Phone <br /> s.. ---------------- -------------- - ------ <br /> G <br /> Address .,f`� � ----.---•--..._ l <br /> .._.___ ________________ <br /> Contractor's Name_____:__ _ __ Jf - - one ��` ��• � <br /> Installation will serve: (Residence 5'? Apartment.House ❑�C'ommercial ❑:Trailer Court ❑ Motel El Other El <br /> of living units: `- Numter of:.bedrroo s,`$--_ Numbertoffb the --y--- Lot`size ----- �C.�t, ------------------------------- <br /> Water Supply: Public system` iCom unity system-❑ Private'❑, Depth tto Water Table _3_1511ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel-❑] S�a d Loam ❑ Clay Loam-E]—Clay ❑ Adobe)' Hardpan ❑ <br /> Previous Application Mader Yes ❑ NoX New Cons`tFucfion: `Yes No ❑ " ~- <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool 'permitted if public sewer is available within 200 feet.) <br /> pti Tank: Distance from nearest well----------------- Distance from foundation_________________ Material__._________-_- <br /> No' of com artments_--_- -�_---- ._ _Size#_..__i" �_ 4` <br /> p -x-i;..Liquid depth Capacity-•--------------------- <br /> Disposal Field:. Distance from nearest wel1A-a.__ -_Distance from .f undation----------- `__:_,�€)istance to nearest lot line---Z d -•_ <br /> r --Lengthtof each line------3_Q__s_.____'-__--Width of trench------2_y"________________ <br /> ® j Number of lines-_--______-__:___ <br /> . Type of filter ate;ial-._ c_ ErDepth of,-filter material_._._/k___ ____.Total length__:___3d___________________ <br /> -------- <br /> Seepage Pi#: Distance to nearest wel}'_l0 -.-'-t---Distance rom foundation____ a -____.Distance to nearest lot <br /> { ,Number of pits--------/ Lining maten.aSize: Diameter____ "- <br /> �-Deptn_ /.. ------ <br /> Cesspool: Distance from Nearest well----------------±. _Distance--from-foundation-----4777Lini'ng material-------------------------------------- <br /> El Size Diameter-------- ----"-7�---- -------4__:Depth r_- = = pELiquid'.Capacity gals. <br /> Priv Distance from nearest well___._.---------------------------------` . - <br /> y'; Distancefrom.nearest building------------------------------------------ <br /> ❑ } ---- ------ _ <br /> Distance to nearest lot I ne._.-_'_.._ y <br /> e <br /> Remodeling and/or repairing (deJ ibe):---------------------- = ; 1 <br /> ------------•------------ ---- <br /> - <br /> t ----------------------------------------------------- --------------- <br /> •------------------------------------•------------------------------------------------------------- ------------------------------------------------ <br /> ------------- ------------------•------- ----------- <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 County I <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> [Signed]------ C� _ .- --` -- --------------- r--- '"'"- -:----------4-- <br /> -- <br /> (Ow der and/or Contractor) <br /> Y' ,..,_ [B •------------ -� Title -- <br /> [Plot plan, showing size of lot, location df system in relation to wells, buildings, etc., can be placed on reverse side]. <br /> ` r I <br /> FORDEPARTMENT•USE ONLY--J <br /> i - <br /> APPLICATION ACCEPTED BY---- __ _ <br /> -��. -- -� DATE----- I��.,�i - ' <br /> REVIEWED BY------------------------------- ----- ------------------------ --------=--------------- DATE---------/- <br /> - - ---------------- <br /> BUILDING PERMIT ISSUED---------------------------------------------------------------------- ------------=---------- DATE----------- <br /> -----�-- <br /> Alterationsand/or recommendations-------------- --------------_1-------------------------------------------------------------------------------------------­------------------ <br /> ---------------------------------- <br /> ---------•---------------------------------------------•----- -----------•------------------------- --------------------------------------------------------•------••-•---•----------------------------------------------- --------- <br /> -----------------------•-------------------- ----------------------------------------------------------------------------------------- ------•-•-------------------------------- ------------------------------ <br /> i! <br /> F]NAL INSPECTION BY::: :- -" _ :--------=.-`"-=-------=-------- Date=-= ...... J i -------------------------- - ------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 Soufh American Street 300 West Oak Street 132 Sycamore Street e14 North "C' Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M ; Revised W-2100 <br />