Laserfiche WebLink
APPLICATION FOR SANITATION PERMIT Permit No. <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 wo erein described. <br /> This application is made in compliance with County OrdNo. 549 <br /> Ordinance e cribed. <br /> . <br /> JOB ADDRESS AND r CATION -------A _/4&01Wj0A_ <br /> ------- ---- <br /> Owner's Name Z_ <br /> Phone <br /> ----- -------- ------------------------------------------ <br /> - -------------- <br /> Address 2�41_x* <br /> Contractor's Name-,---------------- --- -------------- - -------------------- <br /> -------- Phone-------------------------------- <br /> A r ment House ❑ Commercial Trailer Court ❑ Motel Other ❑ <br /> Installation will serve: Residence ------- --------------------------- <br /> 9 ote <br /> "'o <br /> Number of living units: ---/ Number of bedrooms Number of baths .-f--_. Lot size <br /> Water Supply: Public system E] Cornm unity system 0 Private E] Depth to Water Table <br /> Character of soil to a depth of 3 feet: Sand 0 Gravel 0 Sandy Loam 0 Clay Loam ❑ Clay F] Adobe Hardpan <br /> ❑ <br /> Previous Application Made: Yes 0 No 1< New Construction:- Yes No 0 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Dis+anc from fours n----1-0---------Mti <br /> V ------------- <br /> Septic, Tank: Distance' from nearest ell,7_1�6 <br /> No. of compartments--.--------Z <br /> ....... Size Liquid depth__---_ <br /> apaci <br /> apacify---- <br /> Disposal Field: Distance from nearest wel,I_A��_Distance from foundation""___-2-0------Distance to nearest lot line---/_0_0__. <br /> Number 'of lines-------- -- ---------oLength of each line------- Width of french------- <br /> Type of filter material, tDepfh ci� filter material.........tf_�---t.'---'Tofal length-------10_0------------------------ <br /> Seepage Pit: Distance to nearest well------ ---------------Distance from foundation-------------------.Distance to nearest lot line---- -------- <br /> El Number of pits----------------------Lining material-_---------------------Size: Diameter------------------------Depth------------- ------------------- <br /> Cesspool. Distance from nearest well-----------------Distance from foundation--------------------Lining material_--------------""":_ <br /> ❑ Slzt-,: Diameter--------------------------- ---------Depth----------- <br /> CapacitY - a1.v <br /> Privy: Distance from nearest well------ ------------------------ Liqu.i� <br /> --- ---------Distance from nearest building- ---------------------------- <br /> El Distance to nearest lot ----------- <br /> -------------- - ----------------------- - <br /> ------------------------------------- <br /> 0 -A----------------------•--------------------------------- <br /> ------------------------------ <br /> ling arlid/Zo <br /> rep <br /> -------- --------- ----------- -- ---------------------------- ----------------------- <br /> ------------------1-------------------------------------- -A-------------------------------------------------------- <br /> --------- ----- ------- ------ ------ ----- ------ -- -- - <br /> I hereby certify that I have prepared this application and that the work__will be done in accordance w.ifh San Joaquin Count---------- <br /> ordinances, State laws, and rules-mid regulations of the San Joaquin Local Health District. <br /> (Signed)--------z,�_ <br /> ---------------------------------- ------------------------------------------- <br /> ---------------(Owner and/or Contractor) <br /> By:----------------------------------------------------------------------------------------------------------- <br /> --------(Tif le)----------------------------------------------------------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed-on're'verse side). 1� <br /> Is <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------------------------------REV -­---------- V - ---------------------------------------- DATE <br /> IEWED BY--------------------------------------------------- DATE- <br /> -------------------------------BUILDING PERMIT ISSUED-------------- ---- -7---- - ---- ---------------------------------- <br /> - <br /> - <br /> --- ---------------- - --- 14 ----------------------- DATE----- _ ----------- --------- <br /> --- ----- - - <br /> Alterations and/or recom d f,0 �-j- --, <br /> ---- <br /> --------- ---- <br /> ------- <br /> ----------------- - <br /> -------- ---- <br /> ------------------------------------ ---------------- ----------- ....41- <br /> ------------ ------------- -- ----------- --------------------------------------------------------------------------------------------- <br /> --------------------- <br /> FINAL INSPECTION BY:.---- Date <br /> Date-.3 — – <br /> ------------------------------ ... . <br /> ------------I------------- <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 10-52 Revised W-2100 <br />