Laserfiche WebLink
f-UK UrrK-.t USE: <br /> ------------------------------ <br /> APPLICATION FOR SANITATION PERMIT Permit No. �`m5 � <br /> ------------- ------------------ --- ------ (Complefe•in Duplicate) <br /> ------------------ ----- ------ - ----------------------- This Permit Expires 1 Year From Date issued Date Issued &1 V!V_-6;-7 <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-_ <br /> ----------------------- <br /> r----C,--• <br /> Owner's Name ��~ ` <br /> - ----------- Phone <br /> Address---- <br /> --•- -- ---- --�--------------••-- - - <br /> Contractor's Name------ _- ----- C ------- 1--- —�—�--------------•--- Phone--- <br /> Installation <br /> hone-Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -- _ Number of bedrooms __Z.- Number of baths _/-__ Lot size <br /> Water Supply: Public system ❑ Community system ❑ Private ❑­15epth to Water Table 149- ft <br /> Character of soil to a depth of 3 feet- Sand a---G'ravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay E] Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date...... ------- ) No ❑ New Construction: Yes ❑ No �HA/VA: 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 /> ----•------- ----------- <br /> No. of compartments -- ----Size--------- ---------- -----Liquid depth--------- ------ ------- Capacity....................... <br /> Disposal Field: Distance from nearest well.'=�3f `-Distance from foundation__/A9_._.-..Distance to nearest lot line-Zo <br /> Number of lines---------___-_ Length of each line-. le-OZ--- --.__.Width of trench-----��_`�_-.________ <br /> - ----- ----- <br /> Type of filter materials �c�!-.--Depth of filter material---/_�______----- <br /> Total length--- G?la.-----__ - <br /> ----------- <br /> Seepage Pit: Distance to nearest well-------- -------------Distance from foundation--------------- <br /> ---Distance to nearest lot line__-__._.___..__-_ N <br /> ❑ Number of pits--- --------- ------Lining material---------------------- Size: Diameter.--------- -----------Depth------------------------- ------ <br /> Cesspool: Distance from nearest well ----------------Distance from foundation-------------------Lining material----------------------_.----_-.---_. <br /> ❑ Size: Diameter- -- -------- --- -------- ----Depth--------- .....------------ -r---------- --- -Liquid Capacity- --------- - --------gals. ' <br /> Privy: Distance from nearest well----._------------------- ----------------- - --Distance from nearest <br /> ❑ Distance to nearest lot line building, <br /> Remodeling and/or repairing (describe):_. ......-------------- <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, S e laws and rules d re lations of the San J �quin Local Health District. <br /> (Signed)-------- L- = -�- --- <br /> -/- --- - <br /> ----------- -------- ------ --------- -- :�Ow rand/or Contractor) <br /> or <br /> By:. - ------- -----•------.-------- = -- �- - -----------Title <br /> (Plot plan, showing size of lot, location of stem in re ation to wells, ildings, etc., can be placed on reverse side). <br /> FOR DEP RTMENT UX ONLY <br /> APPLICATION ACCEPTED BY . - - --O ------I-------------- DATE 1-1 -x� <br /> REVIEWEDBY------------------------------------------ ---------------------------------------------------------------------------------- DATE-------- .-------- <br /> - <br /> BUILDING PERMIT ISSUED-------- -- ---------- DA•TE_-_--_.__._._________------- -.-- <br /> ---------------------------------------------------- <br /> --------------------- <br /> Alterations and/or recommendations:..-__-.--.-.._ <br /> --------------------------- ----------------.------•---------------- <br /> -------------------- --- ------....... ._. <br /> FINAL INSPECTIO Date--......- ----- -- <br /> - - --------- ----- ------ - - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haz*lton Ave. 300 West Oak Street 124 Sycamore Street <br /> 20.5 West 9th Street <br /> Stockton,California Lodi, California Manteca, California Tracy,California <br /> E.H.9 2M 1-67 Vanguard Press <br />