Laserfiche WebLink
APPLICATION FOR SANITATION PERMIT <br /> '; � (Complete in Duplicate) <br /> Application is hereby made totheSan 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 /> �s3 l -----lel ------------------------------------------------------`-------- <br /> JOB ADDRESS AND LOCATION =_ - ` e <br /> rLra �-2=Phone-Owner's Name Z <br /> Address. _--- - ------------------------------------------ <br /> :J <br /> ----------------------z� ( ,n <br /> Contractors Name----------------------------- -------------------------- <br /> --------- ------------------------------------------------ ----- Phone----------------------------------- <br /> - - <br /> i <br /> Installation will serve: Residence Apartment House E] Commercial% Trailer'Court ❑ Motel E] Otherr El <br /> Aliaw <br /> Number of living units:. Number of bedrooms. Number of.bahhsgZ Lot size-------- ---------------------- <br /> Water Supply: Public system Community system ❑' Private ❑ <br /> Character of soil to a depth of 3 feet:- Sand E] Gravel ❑ Sandy Loam F1Clay Loam ❑ Clay ❑ Adobe Hardpan E] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from,neares+ well-----------------Distance from foundation--------------------Material----------------------------------------------- <br /> No. <br /> _--.-_________--_.___________-_--________---No. of compartments--------------------------Capacity-----------------------Size--------------------------------Liquid depth------------------------- ~` <br /> Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material__________f__________-.____________. <br /> ❑ Size: Diameter----------------•---------------------Depth------------------------- -------------------------- <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-----------C3-,b-j_-________-----. <br /> ❑ Distance to nearest lot line------------------------------------------------ <br /> Seepa a Pit- Distance to nearest well--___-`fir__-__--Distance frPP��}} f�o�uJJ,'�dation----l0�---------.D' tante to nearest Int line-__e��____.. � <br /> Number of pits__.-----/-----------Lining material_��. _!_r�1_T_Size: Diameter__---�-------------Depth------- - � - <br /> x -' <br /> Disposal Field: Distance from nearest well_______ ______.D-istance from foundation____---- -_-__Distance to nearest lot line__ <br /> Number of lines---------------/-----------------Length of each line-------- d --------- of trench_____-___2-44ff� <br /> NumberDK <br /> of filter materiaLllv-_t�L_� _f__Depth of filter material---__J10-__-_---_ <br /> � � y --- <br /> Remodeling and/or repairing (describe)------=------ -•- - ./�� ---------------------------- ----------------�-------•------------•--------•-----•----- <br /> - <br /> -------------- <br /> --- <br /> -i - <br /> - <br /> ----------- <br /> I hereby certify that l have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances,Eowing <br /> nd rules and' regulations of the San Joaquin Local Health District. <br /> w ___________________________(Owner and/or Contractor) <br /> (Signed)----- -- ------------- ------ <br /> Title(Plot plans, of lot, locati n of system in relation to wells, buildings, etc., must be filed with this application). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-------------- ____ <br /> ------- DATE---- ds <br /> REVIEWEDBY------------------------------ --------------------------------------------------------- ------. DATE------e--' ------ <br /> ier <br /> BUILDING PERMIT ISSUED------------ •------- --------• DATE--------- -.!T --------------------- -------------------- <br /> Alterations and/or recommendations------------------------------------------ ----------------•--------------------------•--------------•---------------------------------------- <br /> -------------- ----------------•--------------•------------ <br /> ------------------ <br /> --------------------------- <br /> PERMIT No------- --------- ISSUED--- -i2..:1__ .'5--D-------------(Date) FINAL INSPECTION BY:------- - ----- -------------------- -------------- <br /> -------------- <br /> / 'I <br /> Date-----------------------------------i! <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> T.dq� <br /> 130 South American Street <br /> Stockton, California <br /> ES-9-2M 9-50 W=1639 / <br />