Laserfiche WebLink
APPLICATION FOR SANITATION PERMIT Permit <br /> (Complete in Duplicate) Date Issued -------- <br /> gplicA construct&,, ,nTa <br /> a4-ion is hereby made to the San Joaq�in Local Health District for a permit to constru f d install 1111 the work herein described. <br /> This <br /> application is made in compliance with County Ordinance No. 549. <br /> . ... . .........r <br /> JOB ADDRESS' �-AND gOCATION---- t>---/5 d ------------- <br /> Owner's Name.. 01 <br /> 4�� ------------------------ ------------------------ ---------------- <br /> Address..��6_1------------------ 4� . <br /> - ---- ------ ------------------- ------------------------------------------------------------------------------ <br /> Contractor's Name-------- - - -------- -F........... r ►------------------------------------------ Phone_ _._/ <br /> Installation will serve: Residence E] Apartment House El Commercial F1 Trailer Court El Motel <br /> E] other <br /> Number of living units: *--- Number of bedrooms -------- Number of baths -------- Lot size ----------------- <br /> Water Supply. Public system Ej Community system El Private El Depth to Wafer Table� ft. -,IlL <br /> Character of soil to a depth of 3 feet: Sand [:] Gravel E] Sandy Loam E] Clay Loam E] Clay E] Adobe B--H-ardpan ❑ <br /> Previous Application Made: Yes Ej No E] New Construction: Yes E] 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 T nk: Distance from nearest well l from foundation---/V.........Mater'ai--- --- --------- ------------- <br /> No. of compartments--------- ----------Size-il" jV"- Liquid clepth---5�1_'rf-- --------Capacity- &440 <br /> / 47 <br /> ---- ------ ---- ---- <br /> D;sposal eld: Distance from nearest well 3_430.1-Distake Trom1,_,=tion__/_&.........Distance to nearest lot line.-,-/ <br /> Number of lines........3............ Length of each --------_-.Width of trench---__v--- ------ <br /> filter <br /> Type or' *__-__Depth of filter material-- ----.-Total length__ 0,0---------------------------- <br /> 1.1;:_a-aciq4foundation;. __=.-.Distance to neard`s`!i­tM+r-re----y4. <br /> SeXe Pit: Distance to nearest welIJZ ---- --- <br /> -7 <br /> nr1V;_ "Ir L <br /> Number of e 10 -14-1 -- --------Sife:�Diameter_..._ __ -----------Dep7fn---*_V----- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation._-._---____.-..._. Lining maferial------------------------------------- <br /> ❑ Size: Diameter--------- ------- -------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well----------------------------- ---------------.--Distance from nearest building._-------____-__________--__-_.-.______. <br /> ElDistance to nearest lot line---------------- ------------------------------------------------------ --------------------------------------------------------------------- <br /> 1Z, <br /> Remodeling and/or rep6iring (describe):.....*_ ---------- <br /> -- -- - ---- --- ---------------- - - ----- --- --- ---------I-------------------------------------------------------- <br /> ... ..................---------------------- ----- ------------------------------------ <br /> ---------kZ <br /> -_._----------------_____..._---------- -- ------ --------- :-- --------------------------- <br /> -------------------------------------------------- --------- ---------------------------------------------------- -- -------------------------------- ------------- <br /> I hereby certify that I have prepared this application and thatilhe"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)---------------------------------------------------------------------------- ------------- -- ---- or Contractor) <br /> ---------- <br /> ----- --- ------ -- -- --- - ----- --- <br /> By:------------------------------------------tion'''of-'sysi-e-m--in',_ie`1_a_fion_to_______ --- ------------------ <br /> (Plot plan, showing size of lot, loca' ails, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-------------------- ---------------------------------------------------------------------------- DATE------------------- - <br /> REVIEWED <br /> ATE------------------------REVIEWED BY------------------------- ------------------- ------------------------------------- ------------------------------------------ DATE---------------- ------------------------------------------- <br /> BUILDING PERMIT ISSUED------------ --- - -------------------- ........ DATE----------------------------- <br /> --------------- <br /> 7 ----------- - <br /> ----------- ­------- <br /> Alterations and/or recommendations. ----------- --- ----- ------ ------ <br /> ----------------------------------------------------- ------------- ----- ---- --- ----------- ----- ----- -- ------- ----- - ------------- <br /> ---------------------------------- ------------------------------=------------------------------ ----------------------------- -------------------- --------------------------------------- <br /> ------ <br /> ------------------------ --------------- -------------------- -------------- ----------- ----------------------------------------- ------------------ -----------­------------- ------ <br /> --------------------------------------------•- ------ ---------------------------------------------------------------------------------- ---------t------- <br /> ---------------------------------------- <br /> 'INSPECTION BY:...... 5.e7 -------- ------------- Date-------iX `" G --------- <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 /> ES___9_ZM 145446 ATWOUD 12-54 <br />