Laserfiche WebLink
APPLICATION FOR SANITATION PERMIT Permit No. ./� <br /> (Complete in Duplicate) !/I <br /> Date Issued --- <br /> .y 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 Or inance No. 549. <br /> G <br /> JOB-ADDRESS AND LOCATION... _ <br /> - <br /> Owner's Namer1 - --- -- ----------- ------------------------------- -- Phone <br /> Address2 -----------------------------••-----------------•-••------------------------•- _ --­------- <br /> Contractor's Name--.-- ----1 Wil/ ------� �-------: -----••--------------------------------- Phone <br /> Installation will serve: Residence ffAparfmenf House❑ Commercial [ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _,)--_ Number of bedrooms -- . Number of baths f -- Lot size -----4�0_ _?�_,h;�. _____-•_---- --- <br /> Water Supply: Public system :Community system ❑- Private ❑ Depth to Water Table _14-1-1 ft. <br /> t Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br />` Previous Application Made: Yes ❑ No V9. New Construction: Yes O�,, No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> __0. <br /> Septic Tank: DistanceF from nearest wel{_ _ 71j2—Distance from foundation-->� /.-----Material____ Ol <br /> No. of compartments----- ------------ ---- -- Capacity..---/alt... <br /> Disposal Fiefd: Distance from nearest weE &49' stance from foundation----_--. _ ! <br /> 5--------Distance to nearest lot line. <br /> [ Number of lines--------- _. Length of each line__, °-.x-�.� Width of trench-. �L __------_--•--- <br /> Type of filter materiaL_� --_�� _� Depth of filter material---..� .----___Total length----- -----------__-_------ Yl <br /> F Seepage Pit: Distanceµto nearest well --------------------Distance from foundation--------------------Distance to nearest lot line-------.---._-_-. <br /> ❑ Number of pits----------------------Lining material-_---------------------Size: Diameter.----------------------Depth--------------------- . _Cesspool: Distance Distance from nearest well-----------------Distance from foundation-----.------------- Lining material-------------------------_--------•, <br /> ❑ Size: Diameter------------------ ------ ------------Depth--------- ----------------------- -----------------Li Liquid Capacity Y ----gals. <br /> Privy: Distance"trom nearest well----------------------------------------------___Distance from nearest building__-.----_---.----------- <br /> ❑ Distance'to nearest lot — ------------ - - <br /> l <br /> LD <br /> Remodel'ng and/ repairing (describe):__ ------------------- <br /> _ <br /> ---------- <br /> -- <br /> _ - .. -�. -.• :------------------------------•------------------- ----------------------- <br /> ---- ------------------------•----•-----------------------------•-------------------------•--------------------------------------------------•----------------- <br /> ---------------------------------------------------- <br /> e - <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, Stat s, and rules and regulations of the San Joaquin Local Health District. <br /> ' r <br /> {Signs - ----------- = <br /> ------------------------------------------(Owner and/or Contractor) <br /> By (Title <br /> ) -------------------------------------- <br /> (Piot 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- ---------------- ----------------------------- m - —�. <br /> --------------- DATE <br /> REVIEWED BY Z- ----Z---- , -----------•---•----- ----•------••---------==-=----- <br /> b ---------------------- ------------------------- ------------ DATE-- <br /> - - ------------- <br /> BUILDING PERMIT ISSUED- ---------------------------------------•---------------------------------- <br /> -•----------- DATE------- <br /> QVC <br /> Alterations and/or recommendations:__.:--------------_•......------------------•---.•---------• --------------__------ ------ <br /> FINAL INSPECTION BY----------- --- DZate- _. - ----- <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 /> 145446 ATW000 12-54 <br /> x <br />