Laserfiche WebLink
U, <br /> APPLICATION FOR SANITATION PERMIT Permit No. ____ - 3.• <br /> (Complete in Duplicate) Date Issued _-- -- <br /> Applica+ion 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 Ordina Sce No. 549. `' <br /> l _ , <br /> .1�� <br /> JOB ADDRESS AND CATION-- ,w 7 -------- - <br /> Owner's Name__ ----s } one <br /> . .......... ------ <br /> Address- <br /> Contractor's Name - <br /> Phone----------------------------------- <br /> will serve: rResid e R Apartment House'. [I Commercial ❑ Trailer Court El Motel ❑ Other 11InstallatNumber of living units: I---- Number of bedrooms :!I Number of baths f&___ Lot size __000611647r --••--------------------- <br /> U <br /> Water Supply: Public system '❑ - Community system '❑ Private JrK Depth to Water Table ft. <br /> Character of soil to a deptof 3 feet: Sand ❑ Gravel ❑ Sandy Loam X Clay Loam ❑ Clay E] Adobe❑ Hardpan El <br /> Previous Application Made: Yes ❑ -No rR s New Construction: Yes DK No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r� <br /> . .. . ... I 1 -- -------- <br /> Septic Tank: Distance'from nearest well-/- _____:distance f om foundation_ <br /> _ Material____'.____ ____- _._ _ <br /> No'. of compartments_____. Size(_ <br /> --�.. _ Liquid depth --- --r-.--------------Capacity_.2�--�------ <br /> x <br /> Disposal Field: .Distance from nearest•we/ll, __:.Distance from foundation---__.___1_-_--._..Distance .to nearest hot)Oe <br /> _________________ <br /> J- r�-•------�Length of each line-----------��a�--------Width of trench__.:!-1-------------- --- --- <br /> T e or filter mate Total ken th------/- __-_---- <br /> Number o lines <br /> naL_ <br /> ------ <br /> Type ,�.�.__-/�CtDepth of filter material_.. _____________ � g <br /> Seepage Pit: Distance to nearest well_- ------1DisfanZefrom foundation--------------------Distance to nearest lot lin --------- <br /> Ar <br /> _-_----- <br /> ❑ ' - ---------- <br /> I�umbarof,pits----------------- �`_Li ing material-----------------'------Size: Diameter.-------•--------------Deptn----------- ------- -- <br /> Cesspool: Distance from nearest well_______________::Distance from foundation-------------------_' Liming material-_.-_-__--__-------.---_-___-__._--. <br /> b <br /> - Li uid Ca acit ------------gals. <br /> ❑ Size: Diameter ------------ `�----- , q. ... p wyF:_ <br /> i Privy: Distance from nearest well-------------� ---..------- ---------------- ---.Distance from nea;rest building----_____" -------------`-- <br /> +{ = ---_ ------------- <br /> _ <br /> -- ------------------------------------------------ <br /> Distance'to nearest 4ot line----------------- ---- ------------ <br /> y r <br /> Remodeling and/or repairing (de$ribe):---------------------------'---------------------•-------------------------------- <br /> I - ­ <br /> ------------- <br /> -- <br /> __________________________ _ .4 --__-__-___-----___--------- <br /> ' .....�.__..._____. --- ---- ----------------------------------------------------------------------------------- <br /> .I ------------I----------------------------------------------------------------------------------y__.-----____.._________.._____________.- <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 nd egulations` .f the San Joaquin•Local',Health District. <br /> A <br /> •__ <br /> (Owner and/or Contractor) <br /> + <br /> (Signed}------ ----------------- <br /> -------------------- ----- t__ _ == _ -----------'{Titl _:. <br /> - <br /> e} <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 <br /> . --------------------------- <br /> ACCEPTED"BYE I -" <br /> ----- ---- --- <br /> ._. _ - ------------ DATE <br /> REVIEWED BYt-------------?--�;----------------------------------- <br /> ' -----------------------------------------------� - --- �--------•-�----------- DATE <br /> BUILDING PERMIT SSUED----•------- <br /> ---------------------------------------------------------- <br /> Alterations and/or recommendations:-------------------------------------- -----•--- ............-------------- <br /> ------••------ -------•----------------•------•-------------- <br /> s ----- -------•-------- <br /> FINAL INSPECTION BY:. ----•---------- - <br /> Date---- !;'' ------------------------------------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 132 S'eamore Street ti' - ' 814 North "C" Street <br /> T <br /> !30 South American Street 300 West Oak Street Y� <br /> W Lodi, California Manteca. California Tracy, California <br /> $tock+on, California <br /> 11 <br /> ES-4-2M ; Revised W-2100 <br />