Laserfiche WebLink
Permit No. _.. _ S___3._--•--- <br /> 1� R APPLICATION FOR SANITATION PERMIT �- <br /> n (Complete in Duplicate) <br /> Date Issued <br /> ___ <br /> A lice+ion is hereby made to the San Joaquin Local Health Disfrict for a perrrti� to co�r ruct and install the work herein described. <br /> ("'*?his application is made in compliance with County Ordinance No. F, <br /> F <br /> ---------- <br /> _______________________________________________________ <br /> JOB ADDRESS A O=CATON=-------------D --.____._ —_____ _____._____- _-- <br /> Phone_ _.. 3 - <br /> Owner's Name----- -- -------------- ------ •---------•-----------••---------------------------------- -- - ------------------------ <br /> ­ <br /> Address................... k ------------- <br /> -\ Phone- •.... <br /> Contractor's Na I� <br /> Installation will serve: Residence 6-"'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ that El <br /> Number of living units: ---t.___ Number of bedrooms _7�Number of baths -1---- Lot size ____ ._�.-.-..7• �- <br /> Water Supply: Public system ommunity system❑ Private ❑ Depth to Water Table _ _.____ ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel F-1 Sandy Loam El Clay Loam ❑ Clay ❑ Adobe + -Eardpan C] <br /> Previous Application Made: Yes No New Construction: Yes 2—No El❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: " <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> �DisposSaTl a+FniMke:f: Distance from nearest well------------------' Distance from foundation____ <br /> ____________--.Material________-_-._.__:_______. <br /> .__.------------------- <br /> Septic Lsgw.d depth Capacity <br /> coart s__-_-_ ----_------- .__Size------------------------ <br /> Distance from nearest well.---------------- <br /> Distance from foundation.---------------_---Distance to nearest lot line_.__.--.__._____. <br /> ------------Length of each line----------- --------- ------Width of trench----------------------------------- <br /> �► Number of linems -total length---------------.-------------------------- <br /> Type of filteraterial---------------- --------Depth of filter material-----.--------------- <br /> I <br /> �r <br /> Seep it: Distance to nearest well.-------Distance from foundation__. _11-4 D'Zoistance to nearest lot lir�.�___--_____. <br /> Number of pits...-.--h-------------Lining material-_r 11___.._.I Diameter____Q-.__------Depth.___.'- -- --------------- <br /> r <br /> Cesspool: Distance from Inearest well- _ <br /> ---------------Distance from foundation....................Lining material____-_-_-___________- _____________. <br /> El Size: Diameter--------------------------------------Depth----------------------------------------- ----------Liquid Capacity_----------------- <br /> gals. <br /> Z. <br /> Distance #rom lnearest well-------------------------------------------- ---Distance from nearest building.__-._.---------------------------------- <br /> -------------- <br /> ---------------- - <br /> ❑ Distance o nearest lot line----------------- ------•---------------------------------------------- <br /> Remodelin and/or repairing describeN` ' ------ <br /> -------_�_ <br /> -------- <br /> 1-----------------------------------•------------ <br /> -------------- ------------------- -----•--------------•--•-------- -----------•------------- <br /> f --------•---•-------------•------------------------------------------------------------•------------•-•--..------------------------------- <br /> } 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, w <br /> �r <br /> (Sig ed)--------- •--- -------+ "--------------------------------------------- ----------------------------------------------- ----------- -- ---- <br /> .(Owner and/or Contractor) <br /> "--' (Title) <br /> (Plat plan, showing size lot, location of system in relation to wells, buildings, etc., can be placed on reverse si <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ----- DATE --- ---------------- <br /> - - ----------------- -------------------- <br /> REVIEWED BY- --------- ----- DATE__ ,f <br /> BUILDING PERMIT ISSUED -------- ------------------------------- - DATE--- --------------------------------•--------------------- <br /> Al#eratians and/or recommenda+ions-------------------------- -- --------------- ----------•----------- <br /> ---------------------------------•-----------------------.-•-----------------.------------ <br /> r ---------- <br /> -------I,RA------*--------- --------------- -J------------- ----------------- ----------­------------ -----------7--------- <br /> ---- ------ •-- <br /> 1 -----------------•--------------------------------- <br /> v <br /> FINAL INSPECTION BY:. A -- ----- Date._._��.-_�._I-__�V��- <br /> ( SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street ' <br /> 300 Wast Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stock+on, California Y Lodi, California Manteca, California Tracy, California <br /> E5-9 1 54.6 ATwO90 <br />