Laserfiche WebLink
FOR OFFICE USE: <br /> -------------/ - ----- <br /> _. APPLICATION -FOR SANITATION PERMIT Permit No. ..1.-�- <br /> ----- .. - ------------------- (Complete in Duplicate) <br /> Date Issued <br /> This Permit Expires 1 Year From Date Issued <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 /> e <br /> JOB ADDRESS AND LOCA ION_. a �i1 ------------------------------------------------------- <br /> Owner's Name------------------ -- -- _ -------------L� _I�_lI _ � _�__ -re�_ "r <br /> j Phone - - <br /> Address -------- - ----�-� - '`rte�------------------------------------------------------------------------------ <br /> ---•........ <br /> Contractor's Name - -- - Phone - -%------------ <br /> Installation <br /> -•-•- ty;;> <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court [:] Motel p Other E]Number of living units: -------- Number of bedrooms Number of baths 1lrLot size .___.-__ ._I_TL__ a_ _________________ <br /> Water Supply: Public system D] Community system ❑ Private ❑ Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[�L. Hardpan ❑ <br /> Previous Application Made: (If yes,dote....................) No New Construction: Yes ❑ No ❑ FHA/VA; Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tapk: Distance from nearest well-----------------Distance from foundation_________C__.__.Material____._______________________________---------- <br /> "fir, � No. of compartments------------- ------- ---Size--------------------------------Liquid depth----------- ------------Capacity--------------T------- <br /> Disposal ield Distance from nearest well____e K�Distance from foundation___.ld--_?_._-_Distance to nearest lot line_._`s_________ \ <br /> Q Q, Number of lines---------------�..-._.-------Length of each line------------1J'___�___-Width of trench--------- '+C"_a--- --------- <br /> --- 4. <br /> Type of filter material---- Depth of filter material---------ICP--__----Total length-----------aST---------------------- <br /> - <br /> \� <br /> Seep ge Pit• Distance to nearest welL_._:.� ___Distance from foundation_"___� <br /> f F <br /> �° /_0-------- to nearest lot line_________________ <br /> �� � Number of pits-------- -----------Lining material-_-----sly, ----Size: Diameter--------'YC.......Depth------- -_---------------- <br /> Cesspool: Distance from nearest well----------------- from foundation____________________Lining material__-_..___--_-_____________..___- f <br /> ❑ Size: Diameter--------------------------------------Depth---------------------------------_------------------Liquid Capacity- ---------------- ---------gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-------------------------------.---_------ <br /> ❑ Distance to nearest lot line------------------- -------- - ----------------------i--------------------------------------- <br /> Remodeling and/or repairing (describe):---------- ->---------------------------------------------------------------------------------------------------------------------- <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 la nd rules and regulati s of the San Joaquin Local Health District. <br /> (Signed)------------------ -------- ----- -- ----------- "-"------ - --- ------------- ---------- --- ---------------- --------------- (Owger and/or Contractor) <br /> By:---------------- "--------- ------------------------------------------------------------------(Title)---------------------- ----- ---- ---- --- <br /> (Piot 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 /> APPLICATION ACCEPTED BY "-------------------------------------------------------------------------------- DATE------ ------- ----------------- '` r <br /> REVIEWEDBY------------------------------------------------------------------------------------------------------------------------------ DATE------ -----------------------------•----------------------- <br /> BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE----------------------------------------- -- --------------- <br /> Alter t s df�r recommends+ions:____--... .. <br /> } r ---------------------- <br /> �" -1 -- -----"rL- r--------- [ — ------------------------------ --------- ------------------------------------------------------------------- <br /> �` ------------ <br /> --------------------------------------------------------------------- -------------------------------------------------- -------------- ---•--•--------------------------------- ------------------------------------- <br /> FINAL INSPECTION BY:-.-------. — --------------------------------- Date '_ ' _ _ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E,Haieltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,Ccillfarnia Lodi,California Manteca,California Tracy,California <br /> -.r <br />