Laserfiche WebLink
APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) <br /> Date Issued <br /> t <br /> '2; <br /> (�TA�plicafion is hereby made to the San Joaquin Local Health District for jpac�rn.it to construct and install the work herein described. <br /> 's <br /> application is made in compliance with County Ordinance No. 649. <br /> JOB ADDRESS AND LOGATI <br /> ---- ------- --------------------------------------- ---------------------------- <br /> Owner's Nam ------dZ------- -- ---------------------------- -------- --------------- ------------- Phone --------Z1/_07 <br /> ------------------------ --- -- --- <br /> Address- - ---------------------- <br /> --- --- ---- -------- <br /> Contractor's Name----- -------- - -- -- ------t Phone-.-- <br /> Installation will serve: Residence Apartme House E] ornmer ial E] Trailer Court E] Motel E] 0 her E] <br /> AZ7- Number of baths /--'- Lot size, -- -------- <br /> Number of living units: Number of bedro,oms <br /> Water Supply. Public systemxCommunity system ❑ Private [] Depth to Wafer Table�_�_ ff. <br /> Character of soil to a depth of 3feet: Sand E] Gravel E] Sand Loam E] Clay Loam Ej Clay 0 Adob <br /> ' ,y e*�Harclpan E] <br /> Previous Application Made: Yes E] No New Construction:. Ye No 'FHA/VA: Yes E] NAi-NEr <br /> TYPE OF INSTALLATION AND SPEC fFICATIONS: <br /> (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) <br /> ptic T k Distance from nearest well_________________Distance from foundaf�on--------------------Material--------------------------------------------------- <br /> No. Of compartments----------------------....Size--------------------------------Liquid depth--------------------------Capacity----------------------- <br /> i d. Disfanc'-e from nearest well-------------------Disfance from foundation--------------------Distance to nearest lot Fine_______-____----. <br /> ispc�s5l.. <br /> Number of lines-----------------------------------Length of each line---------------------------7-Vidth of french-------_--------------------------- I <br /> '� Type <br /> rench----------------------------------- <br /> Type of filter material----------------- Depth of filter material____.____________ __ TotalIengfh-----------Seepa a Pit: Distance to nearest we __-____Distancedatio _.Distance to nearest lot kin <br /> Number of pits--____._r._____7--Lining material-Size: Di efer---- ----------Depth----lcp�;--- ------ ----------- <br /> Cesspool. Distance f,_oM'rnearesf well------------------Distance from foundafior---------------------Lining material_____._-----___--_--._------_____--__ <br /> 171 Size: Diameter----- ------------------- ----------Depth----------------------------------'-------_-- -:--Liquid Capacity----------------------------gals. <br /> • Privy; Distance from-nearest well----------------------------=--------------------Disfance from "nearest building--------------------------------------.--. <br /> ❑ Distance to nearest lot line--------------------- --------------------- ------------ --------- ---------------------- --------- -------------- <br /> Remod g n —re <br /> pairing (describe):---------' -------- - --- ------ - -- ----- -- ---- ------- --------- -------- <br /> -----------------------------------------------------------I------ -------------------- ---- ----------- --------------------------------------------------------- -------------- <br /> ----------------------------------------------------------I--------------------------------------------------- ----------------------------------------------------------------------------------------------------- <br /> -------------------------------------------------------------I----------------------------------------------------------------- -------------------------------------------------------------------------------- <br /> ere6y certify that I have prepared fh' application ,Ind thate work wi e"done in accordance with San Joaquin County <br /> ptic T k" <br /> P. ------------- <br /> D i et, <br /> ------- -------------- -- --------------- ------------ -------- ------------- <br /> --------------------- --------- ---- ----------- ------------ ----- <br /> ----------------------------------------- -------------------- <br /> -----_------------ <br /> ordinances, St )f h Joa ui <br /> ,*�aws. an ules and g i sof Local fh District. <br /> -(Signed)------ --- - ---- - - ------ - -- - - ---- --- ------------- ----- Owner a r Contracfor) <br /> By:------------------------ ------------ ----------------------------- -- -------- ------------------- <br /> (Plot plan, showing siz ot, to ion st m in re afi6n to wells, buildings, etc, p can be ed on reverse <br /> FOR-APARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----------- ------- --------------------------------- DATE------- 1 ------------------------------- <br /> REVIEWEDBY--------------------------------------------- ---------------------------------------- -------------------------------------- DATE------------------------------ ----------------------------- <br /> BUILDING PERMIT ISSUED---------------------------------------Z:------------------------------------------------------------- DATE------------------------------------------------------------- <br /> Alterations and/or recommendations------- ------------------------------------------------=------------------------------------------------------------------------------------------•------------- <br /> ---------------------------------------- <br /> ecommendations------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> ---------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------ --------------------------------------------­-­--------------------------------------------------------------------I----------------------------------------------------------------------------------- <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ---------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> - -------------------- <br /> FINAL INSPECTION BY:---------- --- Date----------- ------- -- ----------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 Wait Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M Rev;sea 1-57 F.P.00. <br />