Laserfiche WebLink
APPLICATION FOR SANITATION PERMIT NO Permit No. ...... <br /> (Complete in Duplicate) V Date Issued <br /> Applica+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. 549. <br /> e?2-t-Z- I - <br /> JOB ADDRESS AND LOCATION------j_.Y---- -it---VIL..e, <br /> �1_ ­------------- 61�p-----O-Z __"..... ------- <br /> Owner's Name.. ���, <br /> /J., -ca_y.. ....... 4y �/ ------------------- Phone..--•---........_ <br /> -- ----- -------------------------------------------------- <br /> Address--------4e,_.- ---- --------- ------------------------------------------- <br /> 7--"-- --------------------- -------------------------------------------------- <br /> Contractor's Name.....1l-._6.;S� ........... - V). <br /> --s+�_ct, -- --- Phone----------------------------------- <br /> Installation will serve: Residence X Apartment House E] Commercial E] Trailer Court E] Motel 0 Other 0 <br /> Number of living units: .-1.__ Number of bedrooms Numberof baths ____f__ Lot size V(----------------- <br /> Water Supply: Public system El Community system El Privafeid Depth to Water TableS6--- ft. <br /> Character of soil to a depth of 3 feet: Sand F] Gravel El Sandy Loom E] Clay Loam E] Clay E] Adobe 14, Hardpan ❑ <br /> Previous Application Made: Yes [-] No D!L_ New Construction: Yes�No El <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well--,S-0-----Distance from foundation--/-4b-----------Material---- ------- <br /> No. of compartments_____--J�----------------Size__ )C_.�----)(--'?-----Liquid depth__.--4-----------------Capacity----8-6--c)------ <br /> Disposal Field: Distance from nearest well-S_,'6_._.__Distance from foundaflon__,tO..........Distance to nearest lot line___..___..__. <br /> Number <br /> ine----- <br /> Number of lines_--.___11--___._ ------ Length of each line----l)-d----- ---------_Width of trench----- ---I----------- <br /> Type of filter material !-C,.. C, ks---ci----------------- <br /> s i f�filter material--- ------__-Total length----- <br /> Seepage Pit: Distance to nearest well------ ----- ---------Distance from foundation---------------------Distance to nearest lot line--.__-_-_________ <br /> ❑ <br /> ine----------------- <br /> Ell Number of pits----------------------Lining material----------------------.Size: Diameter-------------------..--Depth-----.--------------------.------ <br /> Cesspool: <br /> epth--------------------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation____________.__... Lining material-_.._____.___._____.__-____________❑ <br /> Diameter_-.--- -----------------------------Depth-----:-------------------------------------------.._Liquid Capacity------------------------­--gals. <br /> Privy- Distance from nearest well_.___---_________ __________ ----------------Distance from nearest building__________-__.__________________._.___.._. <br /> ❑ <br /> uilding- ---------------------------------------- <br /> 1-1 Distance to nearest lot line---------------------------------------------_--------------------- ------------------------------------------- --------------------------- <br /> Remodeling and/or repairing (describe):-----X_t:�-----C.0-0,__ss(�'_�-c:ktJs'.)�_------------------------------------------------------------------- <br /> ---------------­­.......­­------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ - i <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 laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed).,,--- -------- -------------- - -- ----- - --------- ------------------------------------(Owner and/or Contractor) <br /> etc.. can be placed on reverse side). <br /> --------- -------- - -------------------------------------------------------- <br /> By:---- ------- -- -------- -- ---------- --- ----------------------------------- -----------------------(Title)---------------------------------------------------------------- <br /> (Plot plan, ow" size of lot, location off cyst in relation to wells, buildings, <br /> FOR DEPARTMENT USE ONLY <br /> -- ------------------------------- ----------------- <br /> APPLICATION ACCEPTED BY................. ........ ------------------------------------------------------------------ DATE------ <br /> REVIEREVIEWED -------------- <br /> WED BY---------------------------- --- ------ -------------------------------------------------------------- DATE_---------------- ---------------------------- <br /> BUILDING PERMIT ISSUED---------------- ---------------- _----------- --------------------------------------------------- DATE------ --------- ----- - -------- <br /> S-1--------------- <br /> -------- --- ---- ------------ -------------------------------------------------------------------------------------- <br /> Alterations and/or recommendations: .... --------------�---—------ <br /> -------------------------------•--------- ------------------- ------------1------- - -------------------------------------------------------------------------------------------------------- ------------------ <br /> 4%. <br /> ---------------- --------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> -------------------------------------­ ------ - ------------- ---------------­­--------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------- ---- ---------------------------- <br /> -------------------------------- <br /> --------------------------------------------------------- ------*-------------------- ------------------------------- <br /> FINAL INSPECTION BY:-.- . -------------- -------- ------------ Date.-..------ ---------------- ---- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 30D West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> E9-9-2M 145446 ATWOOD 12-54 <br />