Laserfiche WebLink
APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) --y <br /> Date Issued ___�---} -------- <br /> Applical-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 Ordinance No. I5499.� j <br /> JOB ADDRESS AND LOCATIONrE., <br /> 6- -- . /e��_�iCrC•y,�----------------------------------------- <br /> ,--- �s---�--- <br /> t../ U /i, <br /> Owners Name-------------- �-• ----------------- <br /> Address...---------•---------- <br /> Con.tractor's Name...... ' �= r -------- ----------- ------------ Phone <br /> Installation will serve: 'Residence. Apartment House [ICommercial E] Trailer Court ❑ Motel ❑ Other El <br /> Number of living units: �_.�_ Number of bedrooms ')---')--- Number of baths ��yA <br /> :&-Lot size ________._ - <br /> Water Supply: Public system ❑ Community system ❑ Private �pth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑. Gravel E] Sandy Loam Clay Loam [:1Clay E] Adobe ElHardpan [j <br /> Previous Application Made: Yes ❑` No Er"' New Construction: Yes No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No;.septic-tank-or_cesspool.permitted rif_public-se er_is,ay.aila6le.an.ithin.200- eat_ - - -- <br /> ` ---- <br /> Septi Tank: Distance from nearest well.�-Q.0" Distance from fo dation--- ------ ----.Material__._'_____ ._-_.._____._. .-_.._._.___- <br /> Size-� - x Liquid depts_-. f..`�. Ca acit ��GG- coo <br /> © No. of'compartments_...t �, P Y (J <br /> Disposal Field: Distance from nearest well_ Distance from=f,nda on__f -`-------Distance to nearest ]of line______. <br /> Len th of each line- �*.l- ..Width of french---�.4-`----_..____------- <br /> Number of lines__��'.-- --j.-. �-�- -r g -__ ,1 <br /> Type or filter material_ ._��_..tU .-.-Depth of filter material-_._-f._I?-ry_----Total length-_.�_�-`--------------------- <br /> Seepage..Pit: Distance to nearest well__-------------------Distance from foundation_----..---_-------Distance to nearest lot line----------------- <br /> r <br /> Number of pits..- -------------- ----Lining material-----------------------Size: Diameter---- -------------.--- Depth- -- - ------- ------------------ <br /> Cess❑pool: Distance from nearest well.-_._---.------.Distance from foundation.-.- _-.__------Lining material-_----------------------------------- <br /> _.. — Liquid Capacity ---------------- ---------gals. <br /> De t <br /> �.. F _. - <br /> 47 <br /> Privy: Distance from nearest well--------------- e-----------------------------Distance from nearest building___-__.______-_------------------- <br /> ❑ Distance'to nearest lot line----- --------------------------- <br /> --------- --------• - --------- ---•------------------------------------- --------------- - -- <br /> Y <br /> Remodeling and/or repairing (describe_------__-------------_-------------------.---------------------------------••-------.•-------•-_-------_----__...__-_-__------------------••------------- <br /> --------------- --------- <br /> --•------- ---------•------•------------------- <br /> ____ ______________---_________________________________________________--------------------.----------------------------------------- <br /> --------- <br /> ______.____.____-______._._.___-_._____. <br /> ______ ___ _________________________________ --------------------------------------- <br /> ! ereby certify that I ave prepared thi plication a that the work will 6 e in accordance with San Joaquin County <br /> ordinances,Vatelaws,-An rules and gula1of the San oaquin Local H Distric . t t(Signed}--- # n Tac-.�. ---------- <br /> re <br /> - itle <br /> ____ — <br /> By:. ... <br /> (Plot plan, showing.size of lot, location of syst elation to wells, buildiq', etc.; can be ac on reverse side). <br /> ~� FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED -- <br /> DATE�---------------------------------------------------- <br /> BY_ ----------- <br /> - ------------- - <br /> REVIEWEDBY------------------------- ----- -------------------------------------------------------------------------- DATE-- <br /> BUILDING PERMIT ISSUED------------ ------------- ------ --------------------- -- <br /> ------------ <br /> ------=---------- DATE.------�n---------------------------------------------- <br /> Alterations and/or recommendations:.---------------------- <br /> - ------- ------------------------------------------ <br /> FINALINSPECTION BY:.------- --`-- ---- ----- ----------------­--------------- Date---- 1------- h-'� ------- --------------------- <br /> # SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 132 Sycamore Street 814 North "C" Street <br /> 130 South American Street 300 West Oak Street TracCalifornia <br /> Stockton, California Lodi, .California Manteca, California� Y. <br /> E5-9-2M 145446 ATWOOP 12-54 <br />