Laserfiche WebLink
y * " APPLICATION FOR SANITATION PERMIT Permit No .... <br /> ®�-- ' <br /> �4 <br /> // (Complete in Duplicate]*r Date Issued T- a_d--5-s/ <br /> . _. <br /> pplica{ron is 1i eby made to the Sarr�Joaquin Local Health District for a permit to construct and install the work herein described. <br /> I <br /> application is made in compliance with County Ordinance'.No. 549. Y <br /> JOB ADDRESS AND ------------------------------ f ; <br /> CATION ------------•--------------- -4 -T <br /> 1 <br /> - �-,- <br /> ---- <br /> -------------------------- v Owner's Name-.-- ----• - ----- ----------•--.�.------• - <br /> a - <br /> � <br /> --------- -------••---- ----------- <br /> Address_____._�l�f:--� -- <br /> --------------- --------- ------------------------------ =- --------- ------ Phone <br /> Contractor's Name------------ ------- •• ... <br /> 0 <br /> Installation will serve: £Residence ❑•N Apartment House Commercial ❑ Trapr Court motel [] -0therA❑ <br /> / ! Fy " <br /> Number of livingaunits: - Number of bedrooms _____. Number of{baths ______ ot size __._-- d. Q•�---- - <br /> i -.. .w. <br /> Water Supply: "Public system'❑ Community `system ❑ :Private x33Depth to'Water Table,14'ff.- <br /> 6 <br /> Character of soil to a4depth of 3 feet ` Sand ❑ Gravel_❑ Sandy Loam ❑ Clay Loam [3 Clay ❑ Adobe Hardpan ❑ <br /> Previous Application Made: Yes E l No New Construction Yes I�No ❑ <br /> t' l_ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS <br /> Distance fro oundati ----------- <br /> de <br /> J t] <br /> (No septic tanV or cesspool�permitte.d I if public sewer-.is available within 2 O <br /> 00 feet.) <br /> Evlaterial------�G� ' <br /> Septic Tank:.- Distance from nearest well ° - <br /> 5 -- Ca acs <br /> No of corn artments_..t. 5ize__-- �vy - quid depth_-'y}______-- 'Capacity <br /> f pik L s fS- Li p <br /> p ' ' {,_.:._} F ---✓d___--`-- bistance to nearest lot line----------- <br /> Disposal <br /> -gt--.- <br /> Dis o al Field: - 'Distance-fro' nearest welf__�_._'_ Distance from foundation 3�,--_---•-___--.Width of trench___-. <br /> Number,of;lmes______'__ ----------------------Length of etch line_____ <br /> : s° +� _ <br /> Type ot.filtar material_.5'�.__ -_-.Depth_of_fiiter +material_ J �- Total length _______ <br /> Seepage Pit;. i '3D�IIu`maber of pis rest ell D Inc} mDate�aal_e from found5ize nDiamete��'_3 Co �:artoDeptest--o�line----------------- <br /> Seep <br /> -----{--------- <br /> Depth `' <br /> �j� ,4 p <br /> Cesspool: Distance fromF,ne'arest well------ ___------Distance fromlfoundation a__..____ °-1.Lining materia!___ <br /> .t_.' a ('fir p ------ _~ - µr—Dista e from nearest building_ <br /> ❑ :. . Li uid -Capacity -------=-• -----------' <br /> Size: Diameter--- - -----_-- De ---------- <br /> ----'--Distance <br /> -------- ----- <br /> Privy:+ Distance #rom nearest well_ i - <br /> d.,.... -«.-,._ - ------ - ---- ------------- <br /> E]❑ -,.... . � . . ..Distance to-nearest lot;'line-'---= '.�,�------- --------- ----- "------•---- --------------- ----------------- <br /> Remodeling and/or repairing (describe)--- ------------- •-----------------1---,------------------------- ---- ---�- I------=-_----•------• -------------------- <br /> •- --' --------------------- <br /> f 1 ---------- <br /> ---------•----- - <br /> -_i I'I t ----------------------­•---------"---•----------- --------- ------------- -------- <br /> -------------------------------,•------ -----•-•------ - <br /> --------------------------------------------------------------------- <br /> ------ r .` r = <br /> I hereby certify that] have prepared this application and that the work.will be,donejn accordance with San Joaquin County <br /> ordinances, State laws,t and rules. and�eegul'ations of t^he San Joaquin Local Health District. <br /> Si ned ---'---- -------_----- ----- (O tor], <br /> ( 9 )----- - . ,Y t. <br /> -- er <br /> } } (Ti le) ----- ------- --- <br /> -- --- <br /> t <br /> (Plot plan, showing size;of lot; lacetion of system n relation to we' lls,:buildings, etc.; can be pl�ced'on reverse side). <br /> FOR DEPARTMENT USE ONLY t T <br /> i <br /> APPLICATION ACCEPTED BY---- == '-------­------------- DATE-------------------------- -----------------•-•------------ <br /> REVIEWED BY----:------•- ':------- A BUILDINGPERMIT 155UED = __ -------- --------- �= ti ------------------------------------------- <br /> --------- <br /> r `p� <br /> ATE-----:-- . <br /> Alterations and/or recommendations________ _____.._ <br /> , -- ------------------------------•---...-------------------------- <br /> ii U -- ------------- ----------- ................... --••••..................-•-•- <br /> -----•----• --- • - -- �.. <br /> t <br /> ----------------------------------------.......... --_.... <br /> 3 --••-------•---------------;-•-•---------- --------•-------- ------•--•---- <br /> t <br /> •...... ........ <br /> FINAL INSPECTION BY:. `� =`__ Date.-.__..:_k. __.-T-_. ... <br /> F SAN JOAQUIN LOCAL. HEALTH DISTRICT <br /> 130 South American Street I 300 West Oak Street 132 Sycamore Street 814 North "C" Sfreet <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M Revised W-2104 <br />