Laserfiche WebLink
APPLICATION FOR SANITATION PERMIT Permit No. 4..� <br /> ,/( r' (Complete in Duplicate) 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 /> } i Ioryw <br /> JOB ADDRESS AND LOCATION----IAV-°--------�C--- =-�lt_ 1-r� -- - } ' / 'o �''�``�� G''°�--------(I��_�'�c� <br /> +6vq R� <br /> Owner's Name-------------------- (-e------- -1J `t � -�_ -------------- ------- ----------- ----------------------- ------------------ Phone----------------------------------34 <br /> Address-------------------------------------------------------------------- -------------------------------------------------------------•-------------------------------------- -----------•-------------••----- )to-^e <br /> rM ft � <br /> Contractor's Name-------------------------------------------0Pli—)�------------ ------------------------------------------------------------------ Phone----------------------------------- <br /> Installation will serve: Residence ) ' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -------- Number of bedrooms __f---- Number of baths ____3_ Lot size ------------j_-_4-'.{/e-P_-_._______-___-_________- <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table _— ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe, 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.) <br /> rf / <br /> Septic Tank: Distance from nearest well____ (1______Distance yfrom foundation--------- __.Material`�_____�171�1_C Y_s^�'.__- -2916 rl, <br /> No. of compartments___--__-Z_'__-�_ Size___r7_�f-__- 11--.?_-___Liquid depth----------y___________Capacity------ ._(_____ <br /> Dis o al Field: Distance from nearest well---50-------Distance from foundation----!;P----------Distance to nearest lot line ---.) <br /> Number o1 lines------------- �____-_______Length of each line---/0-0--_f 55O---Width of french----------j'/�-__-______-:__ <br /> Type of filter material___-1-/i________Depth of filter material_____l�________-_Total length------- _____________________ <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------------- 0 <br /> ❑ Number of pits----------------------Lining material________________-Size: Diameter_____________________Depth_____--_____________________ <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------------------------------------------------------------------------------ ----------------------------------------------------- �p <br /> Remodeling and/or repairing (describe):--------- --- -------------------------- ----------------------------------------------------------- ------------- ------------------------------ <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------- --------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------ --------- <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)�,�r'"" ------------------------------------1 - ------------------------- ----------------(Owner and/or Contractor) <br /> By:------------------------------------------------------------------------------------------------------------------------------------(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-- = <br /> REVIEWEDBY - - ----------- ------------------------ DATE------------------------------------------------------------ <br /> BUILDINGPERMIT ISSUED------------------------------------------------------ ------------------------------------------------ DATE------ ------------------------------------------------------ <br /> Alterations and/or recommendations------------------------------------ ----------------•----- <br /> ---------------------------------------- --------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> ------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------- <br /> ---------------------------------------------------------------------------------1------------------------------------------------- ------------------ --------------------------------------------------------- <br /> FINAL <br /> -------FINAL INSPECTION BY: `.�2��'� - - - - - - Date --------------------------------------------------------- <br /> SAN <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-9-2M Revised W-2100 <br />