Laserfiche WebLink
1� APPLICATION FOR SANITATION PERMIT Permit No. ._73 <br /> (Complete in Duplicated f <br /> Date Issued _____ __fir/it-__ , <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 /> JOB ADDRESS A)& LO ATIO ..o2./_- "!� '� <br /> F <br /> Owner's Name----- s ----'---• M^ --•-------------------- -----------------------------------------.. Phone-------------­­1------------...._ <br /> e" . <br /> Address------ 4-- =-r- /447 Y Contractor's Name---- r <br /> -------- <br /> Installation will serve: Residence partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ___�Number of bedrooms ._.`z-: -of baths __�Lot size ----,`�..C�_-_�_.._J.-�d_________________.____ <br /> Water Supply: Public system 4_ anmunity system ❑ Private ❑ Depth to Water Table 47.3- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ <br /> Previous Application Made: Yes ❑ No r-Eonstruction: Yes ❑ No Hg�- <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic ank: Distance from nearest wall_____:, ,-_{._._Distance from foundation--------------- Material------------------------------------------------- <br /> No. of compartments- ----' --Size--------------------------------Liquid depth--------------------------Capacity-----------•----------- <br /> isposal 'Field: Distance from nearest well- ;1.%#,eDisfance from foundation---_/0- Distance to nearest lot line___ _ <br /> Number of iines----------- .. Length of each line----- _at'_ --------------Width of trench_..._2- `'___________________ <br /> Type of filter material---.- --A#------------Depth,of filter material----l._F-_.__._.._.Total length------- -4_____________________________ <br /> Seepage Pit: Distance to nearest __-__Distance m fo ndation____ /6_.....Distanc a to nearest lot line_.-_fd.,_._ <br /> Number of pits------/--- -.-_Lining material__- . -�-_1-_..Size: Diameter__. j' ,5 Depth- \ <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_------_________._.____._____.______ <br /> ❑ Size: Diameter------- ---- ----------- - ----- ----Depth-------------- -------------------------------------Liquid Capacity----------------------_---gals. <br /> Privy: Distance from nearest veli------------------------------------_-----------Distance from nearest building.____..__--_----___________.._________- <br /> ❑ Distance to nearest lot line.--------------------- -------------------------------------------------------------------------------------------------------------- ------- <br /> Remodeling and/or repairing (describe):------------------ ------------------ --------------------------------------------------------- -----------_----------------- <br /> -----------------=------ <br /> ------------------------------------------•---•--•----------------------------------------------------------------------------------------------------------------------------------••---- -----=--- ------------------------ <br /> - -----------------------------------------------------------------------•----------------------------------------------------------------•------------------------------------------------ --------------- <br /> • 1 <br /> -------------------- •------------------------------------•-----------•-----------------------•-•----------------------------------------------••------------ ----------------------------s <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, la s, an rules and regulations of the San Joaquin Local Health District. <br /> (Signed)..._. ..... -- -- ----- -- ---------------------- ------------- -------------------------------------------------------------=-------�or Contractor) <br /> By:------ - -- -- --- <br /> (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------------------------- ----- -------------------------------------------------- DATE-------S�---------------------------- <br /> ------------------ <br /> REVIEWED BY------------------------------ ---------------- - DAT ------------: .'..----------------•----•---•-•-------- <br /> - -- ----------- - --------------------------------------- <br /> BUILDING PERMIT ISSUED--------------------------------- ----- -- : DATE------- --• ~-j----------------------------- <br /> Alterations and/or recommendations--- ------- ------------- ---- -- ------------ ------------------------------------------------------------------ ----•-•��i= --._.. <br /> -• ------- - ...... <br /> .'• - <br /> �- a , <br /> ---------------------------------------------------------------------------------------•------------------------------------------------------------------------------------------------------------------.---..----_-----.--- <br /> FINAL INSPECTION BY:....__ rJ -------------------------------- ---p <br /> 4. 4---------------------------------•-----••---- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Sfreet 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> E!3- 9-2M 145446 ATWOO❑ 12.54 <br />