Laserfiche WebLink
APPLICATION FOR SANITATION PERMIT Permit Na. .._ <br /> (Complete in Duplicate) <br /> .�� Date Issued __,/1__ p-4TY <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 1s made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATE N---- -------- [ - = - <br /> Owner's Name---------------- I <br /> P190------- /a--------------••---------•-------••---------------- x <br /> -- - -- --- - - ------ ---- ------� Phone ��.�8'-,�-=---------- <br /> Address---------------------------------------•-----------------------------------•--•----- -----------.._..­--------------------------­-­------------­-----••---•--•------------------•---..-...-------------- <br /> Contractor's Name-=--------------------------- '� ��h�� F=------r- -- --••---- - I------------ Phone----•------------------------------ <br /> Installation will serve: Residence M' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -------- Number of bedrooms _ ____ Number of baths -------- Lot size------------- ______:_.__.___ <br /> Water Supply: Public systemz J . Community system El Private ❑ Depth to Water'Table's __:_ ft. A <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> Previous Application Made: Yes ❑ No New Construction: Yes No ❑ I ' <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: A <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ; <br /> Septic Tank: Distance from nearest well___ 0_�_� Distance from foundation______f d__'____..Materia4--------- -r �__________________o` <br /> No. of compartments_______._- --I J <br /> Disposal Field: Distance from nearest well__-_ f?_--....Distance from foundation------ ---------Distance to nearest lot line_-__--b--------- Q <br /> Number o{ lines________. _________________Length of each line_______-r✓�_'-.__4___-_.Width of french---------�2- ----------------- �► <br /> Type of filter material-------064f -----------Depth of filter material------_l�`-.________Total length------------4-0__--_________________ _ _ <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation-----------__-_____..Distance to nearest lot line----------------- <br /> El Number of pits.---------------------Lining material-----------------------Size. Diameter----_--:---------------.Depth--------------------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation----- ------------ lining material-------------------------------------- <br /> ElSize: Diameter------`-------------------------------Depth------------------------------------------'--------Liquid Capacity_--------------------------gal - <br /> Privy: Distance from nearest well---------------------------------------------- from nearest building_______________-____________._____...__. <br /> ❑ Distance to nearest lot.line -----------------------------------------------------4----'------------------------------------- <br /> Remodeling and/or repairing (describe):---_----------------------------------------------------------------------------- <br /> ________________________ _--._ -•_ _ _ <br /> 7- <br /> I <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, Stat ws, an rules and ,regulations of the San Joaquin Local Health District. ' <br /> (Signed) /%�� = ---- -------------------------------------------------- ---------------------(0 <br /> and/or. Contractor) <br /> By=------------------------------------------- --'------------------------------------------------------------------------------------(Title)-----------------------------------=---------- ---------------- <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 /> APPLICATION ACCEPTED BY .......................... <br /> ------------------ -- f�g----------------------------------------- DATE-------- �j — ;; -�--------- <br /> REVIEWEDBY ---------- --'--`----------------------------- - DATE---•------------------------------ <br /> BUILDINGPERMIT ISSUED----------------------------------------------- ----------------•--------------------------------------- DATE------------------------------------------------------------- <br /> Alterations and/or recommendations---------------------------------------------------------------------------------------------------•------------•-•-------------------------------------------- <br /> -- - -- - ---- <br /> ----------------- <br /> --------------------------•-•------------------- <br /> 1 ---�=--��---��,` -�---- -' <br /> " D__ ----- � ''- ----- -k+-------------------------------- ---------------------- ---------------------------------------- <br /> FINAL INSPECTION BY--- ---------- ------- 5-------------------- Date------., -Y------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> x <br /> ES-9-2M 10-52 Revised W-2100 <br />