Laserfiche WebLink
APPLICATION FOR SANITATION PERMIT Permit Ni;. <br /> (Complete in Duplicate) 3 <br /> Da+e Issued -- <br /> Applicafian is hereby made to the San Joaquin Local Health District for a permit to construct and install the work ere' described. <br /> �T#s applic�ZiNt <br /> made ` ice with Co'ynt0 divan a No.r,5¢9. r <br /> JOI3DDRLOCAT N--------------------------------•_--------------------------------------------------------------- --------•-•----• -----=-- <br /> .Owner s N -..-- -- k. .--..... -- ) -�---- ---------- ------ Phone14.----lf7 - b/----- <br /> Address. 2' ''t�4 .:. <br /> �- - <br /> Cont�actor's Name_....-�-- - - -------------------�----..-..----------------------- ----------- Phond ��, <br /> Installation will serve: Residence `Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ t <br /> Number of living units: _A--- Number of bedrooms _-2 Number of baths ---1---_ Lot size ----.----f------------------------------------------------- <br /> Water Supply: Public system .❑ Community system El Private Depth to,Water Table . 'Q_ ft. <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 ja' No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: t <br /> (No septic tank or cesspool permitted.if public ewer is available within 200 feet.. <br /> -Septic;ank: Distance-from.nearest_well - -------- <br /> - -_ Distan a.f om„found�atr.ion- f(_--;_,,-.---Mate-ria"l �? <br /> ^ ------- <br /> No. of com artments.....- Size--_.-_� Liquid de Ca <br /> acct <br /> Disposal. Field: Distance from. nearest well-. Q-.- ':Distance from foundation- --:---a----....Distance to nearest lot ine------- ----- - <br /> �% t JF <br /> Number of lines----------��_�--------------- Length of each line----- d'-.-:.._.:-------Width of trench------ --------------------_-- , <br /> -.-..--De Depth of filter material-_._./2 H-.----.Total length---4 Q------------------------------ <br /> Seepage <br /> --------------------------- •` <br /> Type of filter materiaL��n'_:--.- p <br /> Seepage Pit: Distance to nearest well----I" t-_Distance from foundation---LO------------Distce to nearest lot line--- lyt <br /> [a]� Number of pits-----2.------------Lining mate6al' 1-...--.Size: Diameter-----2 r-------Depth----- jo----------------------- F <br /> Cesspool:' Distance from nearest well---------------'_Distance from foundation---.----------------Lining material-----.----------_--.--___--------.. <br /> ❑ Size: Diameter---------------------- ---------------Depth_{----------- ---------------------- -------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well------------------------.-.--------------------.-Distance from nearest building------------------------------------•----. i <br /> ~« Distance:to-nearest_lot line - = _- ---------------------------------•-------------------- <br /> Remodeling and/or repairing (describe):------ - ----- - -------- -...- --------------------------------•--------_.----.................. 1 <br /> -------•----••------•--------------------------------------------------•----------------------•-•-•------•-------------------- ---------•-------------- -------------•-----------------------•------------------- <br /> --------------.---------••--------•-----------------. -------------------- ------•------------------------------•---•------------ -------------•- . ----- � <br /> ----------------- ----- -------•------------------=---•-------------•----------------•---•------------•------•-----=---------•------•---------------------------------------•---------------------------------------- <br /> I hereby certify that I have prepared this application and that +he work will be done in accordance with San Joaquin,County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> v � <br /> (Signed)--, -------------- ----•-- i - ------------------ ----- ----- (Owner and/or Contractor) 7 <br /> ----- <br /> BY: _ Title <br /> ---- �Ati�"�.1 (Title) 2raqGyp ---.... <br /> .(Piot.plan, showing'size of t -location-of system in.-relation;to-wells, buildings, etc., can,-be-placed on reverse side);— <br /> FOR DERAR <br /> A 3MEYUSE O LY 14 N <br /> APPLICATION ACCEPTED BY -. -��-------------------- --- ----------- -----------=---- DATE--- --------------- <br /> REVIEWEDBY-------------------------------- ------------ ---------------------------------------------- DATE---------------------------------- <br /> BUILDINGPERMIT ISSUED---------=------------------------------•-------------------------------------------- ---------------- DATE- -------------------------- <br /> Alterations and/or recommendations------------------------------ --- - <br /> ----•--------------•---------------------------------------------------------------------------•- _• ------------------------------------------------------.....------------------------- ---------:------------------------ <br /> ---------------------------------------•------.-----,-...----------- ------- ------------ ----------=---------------------------- ------------ -------------------- ----------------------------------------------------- <br /> ,;FINAL INSPECTION BY:------- ----------------------------------------• - ------- m Date.------------ ------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT t <br /> f <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 /> i <br /> 145446 ArWpoo <br /> - .�_ • __ �_ — _ iii. �' <br />