Laserfiche WebLink
Metadata
Document management portal powered by Laserfiche WebLink 9 © 1998-2015 Laserfiche. All rights reserved.
APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) <br /> Date Issued ______ <br /> Applica-lion 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 /> C-vvus C 4sJZ--_ - 0.11— ' <br /> JOB ADDRESS AND LO TION----------�'-l__-/_,.rI-----.�� � � 5 <br /> • Phone------------------------------ - <br /> Owner's Name-------•---•- ` ' ° '�e-.! - ' �.-•--------••-•---------- - <br /> Address ----- • � � <br /> Contractor's Name-------------------------- ' -- ----- <br /> - ----------- one----------------------------------- <br /> Insfallafion will serve: Residence 2"' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _2_-_ Number of bedrooms _ ____ Number of baths _ __ Lot size ---------07�....... ... ......__________.____.- <br /> Water Supply: Public system ❑ Community system ❑ Private 2-16-epth to Water Table--------- ft. R <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ^Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: N <br /> septic tank or cesspool permitted if public sewer is available within 200 fee`) <br /> Septic Tank: Distance from nearest well, Distance from foundation_A4_"iNk. _ .Material__-(71 --A____.___________________._. <br /> No. of compartments- ---------- -- -Size---� _ - _____Liquid depth.___. ______------__Capacity_ _G�-----_ <br /> - -- - <br /> Disposal Field: Distance from nearest well---S4..%u,,,.,Distance from foundation_ "t'�...Distance to nearest lot i'� <br /> [� Number of lines___.______.___ --Length of each line__ 4.4____-__,_____.Width of trench__11_V__._____-_____-__._._ <br /> Type of filter material_-j�A e�=Depth of filter materiaL___f�_.--------Total length-------- _' _________________ <br /> Seepage Pit: Distance to nearest well <br /> __-__Distance from foundation--------------------Distance to nearest lot line.._____.______.__ <br /> ❑ Number of pits----------------------Lining material--------.._.-_.--------Size: Diameter-----------------------Depth--------------------------------- <br /> Cesspool: Distance from nearest well----------------Distance from foundation--------------------Lining material_____________________________________ <br /> ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------Liquid Capacity-.--------------------------gals. <br /> Privy: Distance from nearest well-------------------------- ______________________Distance from nearest building------------------------------------------ <br /> ❑ Distance to nearest lot line-------------------------------------------------------------------------------------- ------------------------------------------------------- <br /> Remodelingand/or repairing (describe):--------- ------------------------------------------•-----------------•-------•------------------------------------------------------------------------- <br /> ---------------------------------------------------------------- ----------•----------------------•----------------------•-------------------------------------------------------------------------------------------- -- <br /> ------------ <br /> ------------I----------------------- <br /> ------------------------------------- -------- -------------- --------------••---------------..-.----------------------------------•-•------------------- ------------ -•- -------- ------ <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Caunty <br />.� ordinances, State la s, and•ru s and regulations of the San Joaquin-Locah-Heeftk Ditttief..� f '� <br /> (Signed)------------j------ ----------------------------------••----------------------------------------------(Owner and/or Contractor <br /> By: (Title)_ <br /> (Plot plan, showing size of lot, location of sys in relation to wells, buildings, etc., can be placed on reverse side). <br /> F R DEPARTME T USE= NLY <br /> APPLICATION ACCEPTED BY-- -- . --- f. f DATE-----�� <br /> REVIEWEDBY-------------------------- ---------- `� --- DATE-------------------- --- -------------------- <br /> BUILDINGPERMIT ISSUED------------------------------------------ ---------------------------------------------------------- DATE------------------ ----- <br /> Alterationsand/or recommendations:--------- ------------------------- ---------- -----•---------------------•------•----•---------------------••--------•--------------------------- <br /> ------------------------------- ------------------------------------------------------ ---------- ------------------------------------•--•-------------------------------------------•------------------------------------ <br /> ------------------------------------------------------- ------ ------------------------------------------------------------ -------------------------------------------------------------------------------------------- - <br /> ----------•----------------•-----•-• ------------------------------------------ --------------- --------•--•------------ --------------------------------------------- -------------------------------------- <br /> ----------------------------------------- - -------------- --------- ---- . --.....-------------- --•----------------------------- ---------- - /---------------------------•-------------------- <br /> FINAL INSPECTION BY:.------- . _- ----- <br /> -------- <br /> ---- ----- Date -- <br /> l <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C• Sfreet <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> E5-4-2M 145446 ATWOOD 12-54 <br />