Laserfiche WebLink
4; N <br /> APPLICATION FOR SANITATION PERMIT Permit No. _.__.r�...A �_ <br /> ' (Complete in Duplicate) <br /> Date Issued ._---------- -3 <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 Ordinanc No. 49. <br /> JOB ADDRESS ASN -OCATION_ �___0__._C'_ <br /> -- ------------------------ ----- <br /> Owner's Name- - ----- -- Phone <br /> f� ----------------------------------- ----- <br /> Address------d--_ C ------ F. <br /> Contractor's Name---- -------- ---- - ----------------------------------------------•-----•-------------------------- --------•----------------------- Phone---------•------------------------- <br /> Installation will serve: Residence [1 Apartment House ❑ Commercial ❑ Trailer Court ❑ go4 ❑ OthefNumber of living units: _L.____ Number of bedrooms __�/_ Number of aths /___ Lot size ____-�------ ________._____________ <br /> Water Supply: Public system ❑ Community system •dam Private` Depth to 1Nater Table -------- ft. <br /> Character of sail to a depth of 3 feet: Sand Gravel ❑ Sandy Loam Clay Loam ❑ Clay E] Adobe Hardpan ❑ C . <br /> Previous Application Made: Yes [I No Sand <br /> Construction: Yes VNNo ❑ I W <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if publ'c;Rt <br /> sis available within 200 feet. <br /> Se tic ank: Distant from ne w I 0 ` /} <br /> p e crest e ' e fro fou _ tion �l- f•' Mat r�I-- -- ------ <br /> [ No. of compartments_____------- t---- ._Si - _-- _- -..Liquid de th------�--------------Capacity---- �- <br /> Dispas Field: Distance from nearest w I4-______ .. istance fro`m`foundation__,I _.__._.Distance to nearest I t Iii e_p__ . <br /> 7 Number of lines____________ Length of each line_______�_ _�....Width of trench_.___ ._ ) <br /> Type of filter yateria._ __- _t-_ -epth of filter material--------/__-_____.Total length--------------�f ------------------- <br /> Seepage <br /> _____-__________ <br /> Seepage Pit: Distance to nearest wel_____ ___________!___Distance from foundation--------------------Distance to nearest lot line______________ <br /> ❑ Number of pits----------------------Lining 4 material-----------------------Size: Diameter-----------------------Dept h--------------------------------- <br /> Cesspool: Distance from nearest well------------- Distance from foundation----------- --------Lining material__.________________________________ <br /> ❑ Size: Diameter ---------------------------- �11 Depth ------- ---------- ------------- ------Liquid Capacity-.--------------------------gals. <br /> Privy: Distance from nearest well-------------- <br /> ---------------- <br /> Distance from nearest building---------- __-----__________._ <br /> ❑ Distance to nearest lot line-----------------------------------------------------------------------4 <br /> 9 and/or d n ; f <br /> /or re apirig (describe):I describe ------------- -----------------------------------------•--•---------•------------------ ----------------------------- <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, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> ( I <br /> (Signed)----•./j I ------ �___-----_--- _ . ........... -------------------------------------------------- ------ ----(Owner and/or Contractor) <br /> ----- <br /> By--------------- --------------------------------------------------------------------- ----------- Title <br /> t { <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY 1 <br /> APPLICATIONACCEPTED BY -- •----------------------------------------------- ----v---------------------------------- DATE ------------------------------------------------- <br /> REVIEWED <br /> .. iREVIEWEb BY ----------------- - --------------------------------------- DATE-- - 1 <br /> BUILDING PERMIT ISSUED --- - .--------------------------------------------=--------------------- DATE----------V -----------------------------------•---- <br /> Alterations and/or recommendations-------------- --•- _- -- -- --------------------------------- ------------•---.—-----------------------1--------------------------------------- <br /> --------------------------------------------------------------------- --------- -------------- ------------------------------------------ ----------------...... ------------------------------------------------------ <br /> ----------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------•-----------------------------I---------- <br /> ---•- -------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------- <br /> ------------------------------------------- ------------ ----------- ------------------------------------------•---------------------------------------------------------------------------------------------------•-------- <br /> FINAL INSPECTION BY: /-�___Ayt,,?)- , Date #�} <br /> V <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-9-2M 10-52 Revised W-2100 <br />