Laserfiche WebLink
APPLICATION FOR SANITATION PERMIT 7 <br /> (Complete in Duplicate) <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 LOTION-------------- S-------- � A---- ---- --------------------------------------------------------------------- <br /> - <br /> Owner's Name------------------ --'y------)%-ICA CA r�, /lr ----------------- ----------------------------------_ Phone------------------------------------ <br /> Address---------------------------------------------------------------- --- V--- - -- -- - - - ---- -- <br /> Contractor's Name------------------------------------------------------------------------------- ------------------------------------------------------------ Phone--------------------- <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other <br /> Number of living units: Number of bedrooms Number of bathsog, Lot size---------tQ---K----- _ _- <br /> PPY: Public ----------------- <br /> Water Supply: system Community system ❑ Private ❑ <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam�!(Clay Loam ❑ . Clay ❑ Adobe ❑ Hardpan 1 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Sceptic Ta k:�- Distance from nearest well-----------------Distance from foundation--------------------Material-------------------------------------------_----� <br /> le xil 1�6- No. of compartme�nts--------------------------Capacity-----------------------Size--------------------------------Liquid depth--------- --- --------- <br /> Cesspool: Distance from neatest well-----------------Distance from foundation------------------- Lining material-------t----____________________-----. <br /> ❑ Size: Diameter---------- ----------------•-------Depth---------------------------------------------------- <br /> Privy: Distance from nearest well----------------------_____----____----__-_---Distance from nearest building________-__----_----_--------__-------- <br /> ❑ Distance to nearest lot line------------------------------------------------ <br /> See�pa�e Pit: Distance to nearest well--____� _---Distance from foundation--------------------Distance to nearest lot line--__----__------- <br /> Number of pits----------------------Lining material-----------------------Size: Diameter------------------------Dept h--------------------------------- <br /> DisRosal Field: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line_________---_--_ <br /> Number of lines-----.- c-------------------------Length of each line------------------------------Width of french----------------------------- _-- <br /> Type of filter maul-------------------------Depth of filter material-----___---ti-------- <br /> } <br /> Remodelin and/or re airin escr �:---------- ------- n ----- <br /> - ---------1y-1----- -f <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 <br /> ordinances, Statte��laws, and rules and regulations of the San Joaquin Local Health District. <br /> St�/ <br /> (Signed)------/ -----�--` ------------ ------- --------(Owner and/or Contractor) <br /> BY:------------------------ ---------------------------------------------------------- -----------------------------------------------(Title)------------------------------------ <br /> --------------------------- <br /> (Plot plans, showing size of lot, location of system in relation to wells, buildings, etc., must be filed with this application). <br /> tWhEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-------------------- -- -- ------------------------------------------------------------ DATE--------- <br /> ------------------- <br /> REVIEWED <br /> --- --------REVIEWED BY------------------------------------------------------------------------------------------------------------------------------ DATE------- -------------------------------------- <br /> BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE-------------------------------- <br /> - -------------------------- <br /> Alterations and/or recommendations------------------------------------------------------------------------------------------------------------------ --•--------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> --------------------------- <br /> ________---- - ------- ------------------------------------------------------------------------------------------------------------- <br /> ---------- - - - --- - ------- <br /> PERMIT No__ _ __ <br /> -------- ISSUED--- ---(Date) FINAL INSPECTION BY----------------------------------------------------------------- <br /> Date----------------- ------------------------------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street <br /> Stockton, California <br /> E5-9-2M 9-50 W-1639 <br />