Laserfiche WebLink
FOR OFFICE USE: <br />--------------------------------------------- ---------- <br /> ----- ---------------------------- ------------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. s ...d <br />------ -- - --------- ---------- ----� ---------- (Comple#e•in Duplicate-)-) Date Issued <br />- <br /> -----------------------r ---- ..-------_-_----------- This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to constructan in all the work herein described. <br /> } <br /> This application is made in/ -. i <br /> a <br /> JOB ADDRESS LOCATIO r ---J­je-,�--- --°�`' �`� I "� !. tl• <br /> Owner's Name--- - .�-� = phone <br /> Address-----o- 1 ------------- ----------------------------------------- <br /> .. <br /> Contractor's Name- - -- ---------•-•- -- ---- -•-• ----- - -- ------ Phone------r----------------•----------- <br /> Installation will serve: Residence p[ "Apartment House ❑ Commercial,[-] Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __ .!__ Number of bedrooms ._ Number of afhs - Lot size ... '`-�----�r�-------------------- <br /> Water Supply: Public system ❑ Community system 0 Private Depth to Wafer 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: (If yes,date_-.---------------- ) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer.is available within 200 feet.) <br /> Septic T nk: Distance from'nearest well---=- -------- Distance from foundation-----I_Q__..._.__Ma for ia -------. <br /> No. of compartments-.-- ';- .---__._...Size_ L_. �1_.,✓ -_�iquid depth------ ._.r.. __...__.Capacity-j"', 6_G._ _ <br /> Dispos Field: Distance from nearest well--•����_.f----Distance from foundation-----e�.........Distance to nearest lot line-47---- --- <br /> Number of lines ----___J-- ----. rti <br /> �. -�._`_„.._Length of:each line__:�0�_ _____________Width of trench..�.__----r_......._.-__-_-_. <br /> Type of filter material--_.. � _>--__ Depth of filter mater'sal-----/4�---- -___Total length---- <br /> See <br /> ' _____.__________ ____ <br /> Seepa Pit: Distance to nearest well...... Q±�_.. Distance from foundation-----1-d_....--..Distance to nearest lot line--_............. <br /> Number of pits..._.- -- Lining material------�_R,— Size: Diameter...._s3.-3----- ----Depth--- - ---------------- <br /> Cesspool: Distance from nearest well ------ ------=Distance from fouhdafion-------.--.--_.- ..Lining material---------------.------.--------.-----. . <br /> ❑ Size: Diameter- -- --------- ----- ---------•------Depth.---------------------__---------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well --------------------------------------.---------D10ance from nearest building------------..._--__---------.----------. t <br /> ❑ Distance to nearest lot line ------------------------ ------- ------------------_:------------------------ ------•-- ----------•----------------------------------------L <br /> Remodelingand/or repairing (describe):--------- --------------------------------- -•- ----•--------------------------------- ----------•------ -----•--------------------------------------- ' <br /> i <br /> ---------------------------------------------------------- --------------------------------------------------------------- <br /> ---------- ------_°__-°-=---------------------------- ----- ------------ --=- ------ <br /> - - -__-•-----•------- ------------------------------------------------------------------------------------------------- - --- <br /> I hereby certify at I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State la s and rules and eguI s of the San Joaquin Local Health District. <br /> (Signed) -- ----- ---- ---------- <br /> By: <br /> -------- - ( /or Contractor) <br /> By:--------------- -�- ------- - --------- ---k------- --- -._-:_..._------- - -- ---------------------------------------(Title)------ - --- --- --- <br /> (Plot plan, showing size of lot, location of system in relatto to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY ' <br /> APPLICATION ACCEPTED BY-__ _ -.-. ------ DATE- __--�� - -2-------------------------------- <br /> REVIEWEDBY-------------------------------------- - -- ._-.--------------------- ------------------------•---------------------------- DATE------------------------------------------------------------ <br /> BUILDING PERMIT ISSUED-------- -- --- ---- --------- DATE----------------- ---------- - -- ---- <br /> Alterationsand/or recommendations:.---------------------------------­­­---- ---------------...-------------------------------------------------- -•--------- --------------------------- <br /> ---------------------------- - -------------------- ----------------- --------- ----------­-------------------------- -------•--------------------------------•-- --------- I <br /> ----------------------- ......... ------------ ---------- ----------- ....................................... - -- --•----------------------------------------..----- ------ ----------------- <br /> FINAL INSPECTION BY: . <br /> s <br /> ~ Date. . .._...... -------- <br /> �� ------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 20.5 West 9th Street <br /> Stockton,California Lodi. California Manteca,California Tracy,California <br /> E.H-9 2M 1.67 Vanguard Press ` <br /> F <br />