Laserfiche WebLink
r � ~ <br /> tl APPLICATION FOR SANITATION PERMIT Permif No. ___ v_---. <br /> (Complete in Duplicate) <br /> Date issued <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 is made in compliance with County Ordinance No. 549 <br /> .� -- <br /> JOB ADDRESS AND LO ATION..-•-$�---�-�,-- .. .------�`-, - • - P---- ---- ------------- --------------------------------------• ---------------------- ----- <br /> Owner's Name--------- ------r f ` PhoneE <br /> Address__-----------_-- ------------------------------------------------------------------------------------------------------------------------------------- <br /> Contractor's Name------------------------------------------------------------------------------ - ----------------------------------------------------------- Phone----------------------------------- <br /> Installation will serve: Residence Apartment HouseCommercial E] Trailer Court ❑ Motel Other <br /> Number of living units: -------- Number of bedrooms.____ Number of baths __ ____ Lot size ---------- y_� q-- ------------------ <br /> Water Supply: Public system Community system El Private E] Depth to ater Table ________ ft. _ <br /> Character of sail to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobekT Hardpan ❑ <br /> Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) �y <br /> Septic Tank: Distance from nearest well Dista fro foun motion___ Q .___.Maters I_ _ ___ ____________________ <br /> No. of compartments_______ ^...________Size__ _ _;__:Liquid depth___-__-__ -___.-____.Capacity__ <br /> -------------------- <br /> Disposal Field: Distance from nearest we(____~"""..Distance from foundatio�n_}___IP---------Distance to nearest lot line____ Q <br /> ❑ Number of lines______________ __ ______________Length of each line_ _-( -_____- {_.Width of trench.......... _ __.-________._ <br /> Type of filter material---- _ ./ _Depth of filter material--- _./+ ......Total length__________f_____ __.-__..___. q , <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line-------------- <br /> E-1 Number of pits.---!-----------------Lining material-----------'----------Size: Diameter--------- -------.----Depth-------------------------------- <br /> I a V <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------------------------------------------ <br /> ❑ Distance to nearest lot line------------------------------- ------------------------------------- ----------------- <br /> ----- ----------------- --------------------------- - <br /> Remodeling an /or repairinescrbe):-------- <br /> �-- <br /> -------.-----'----------- <br /> --•- <br /> --------•t-om---' - <br /> _ <br /> ----------- <br /> - <br /> ------- <br /> ------------------------ <br /> ----------- ------.. - t-- d <br /> -- ------------- ----- ------- -------- ---------•-------r----- -- <br /> ---------------------- <br /> ------------/ --- ---- - -----------•----------------•-- =-- ---1-�--- � ------------ <br /> I hereby certify that 1 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 Joa Qin Lo 1711ealth District. <br /> (Signed) <br /> a r �� .----- 5., /��'�° ----f - {Owner and/or Contractors <br /> By:------------------------_------------------I--------------------------------------------------------------------------------------(Title)---------------------------------------------------------------- <br /> (Plot plan, showing size of lot, location of system in relation'to wells, buildings, etc., can be placed on reverse side). <br /> F <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----.-----1---------- -- --- --- ---- ------------------- <br /> DATE------V <br /> REVIEWEDBY-------------------------------------------- ----- --��------------------------------------ DATE------ <br /> BUILDINGPERMIT ISSUED-------------------------------------------------------------•--------------------------------------- DATE----------------------------------------- <br /> Alterations a d or recom endations_____________________.________,__..________.. - <br /> / / <br /> ---------•------------------•-------------------------:------------------------------------------­____11---------------------------------V----------------. --- <br /> ------------------------ ------------ -----------------•-------=------------------------- ---------------------------------------------------------------- --•--------------------------------------------------------------- <br /> ------------ <br /> -- - --------------------------------------------- <br /> FINAL INSPECTION BY:.---- �/----------------------------------------------------------/=�------ ---------------------------------------------------- <br /> --1 -------------------------------- Date------ <br /> ---- <br /> ...------ ------ ----- ------ ----------------------- - <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 /> ES-4-2M 10-52 Revised W-2100 <br />