Laserfiche WebLink
APPLICATION FOR SANITATION PERMIT Permit No. ... _3__ _D_ <br /> (Complete in Duplicate) S" <br /> Date issued <br /> S <br /> Applica-lion 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 /> •--•----- -------•-•---------------------------------------------••--JOS ADDRESS AND LOCATION__11 ] <br /> y- �� S� <br /> Owner's Name-------- ------------------------------- ---•----- <br /> -(J <br /> Contractor's Name----------------------- ------------•----- ----��---- r- -----'-----'- ----------------------------------- ----------------- Phone-J1-7r---- - <br /> �-- <br /> Installation will serve: Residence:[r]' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living-units: --/--- Number of bedrooms ... Number of baths .-./___ Lot size __--______---____ <br /> Water Supply: Public system ❑ Community system ❑ Private [Depth to Water Table S10 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 ❑1 No p' New Construction: Yes ❑ No <br /> TYPE OF INSTALLATION AND 5PECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> t <br /> epti Tank: Distance from nearest well_________________Distance from foundation----------------.-- Material__________.__.--________________._.__._. <br /> No, of compartments-- --- -------------------Size_._.----------------------------Liquid depth----------------------._Capacity---------- ------------ <br /> ispo Field: Distance from nearest well__.-_.___.__-__Distance from foundation....................Distance to nearest lot line___________-_.__. <br /> *0147 Number of lines-----------------------------------Length of each line------------------------------Width of french......._.---------.---------------. <br /> Type of filter material_________________________Depth of filter material----------.------------ otal length------------------------------------------ <br /> O <br /> Seepage Pit: Distance to nearest est well-/..°__--_-_Distance from,foundation___���__.____.Dista�e to nearest lot line----------------- <br /> Number of pits------ --------------Lining material--- W --Size: Diameter....s3 ------------Dept'n_._--a -------------------- <br /> Cesspool: Distance from nearest well----------------- from foundation_..................Lining mater ial-_.---__.__.---.-----------._.-__-._ `\ <br /> F [] Size: Diameter------------------r------ ------------Dept h..... . . ....................... --------- ----•-Liquid Capacity----•--- ---•---------------gals. <br /> s <br /> Privy: Distance from nearest vrell--- ------------------------ ------------Distance from nearest building----------------------------------------- <br /> ❑ Distance to nearest lot line- ;---------------- --------------------------------•-----------•-------------------------------------------•- ----------------------------- <br /> Remodelingand/or repairing (describel-...----------------------------------- -- ------------•---•------------------•---•-----------•--------------------------------------------------•-------- <br /> •---------•---••--------••---- ----------­-------­---- --------------.-.------ --•-------•--------------•--------------------------------------------•------------------------------------------------------------------ <br /> , <br /> i <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, State I and rules and regulations of the San Joaquin Local Health District. <br /> ��- -_.Owner and/or Contractor <br /> {Signed}--------------------- ---------------- ------r------------------------ ----------------- --------------------------------------------------------- ( � � <br /> By----------------------------- r_,1.�. ----- ��� � --�-----------------• . [T►+le}-,-- F <br /> (Plot plan, showing size of lot, location of system in retion to wells, buildings, etc., can be placed on reverse side). <br /> ,w <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--------------------- ------- ----- -- -------- ------ QATE <br /> REVIEWEDBY--------•-------------------------=k--------- ------ -------------------- --- ---------------------------------- DATE----------------- <br /> BUILDINGPERMIT ISSUED------------ ---------------------------- ----------------•------------------------ ------------- DATE---------------- --------- ------ ----- ----------- <br /> Alterations and/or recommendations:------------------ -- -- -- - -- ---- ------ ------------------------------------------------------ <br /> -1 <br /> ---------------------------•--•---------•-•--•-•--\ = <br /> ---------•- -- ----- ----- - -------------------------­- ----------------------------------------------------- <br /> -------------------- <br /> FINAL INSPECTION BY ..... - Date_..--- ------------LS----- <br /> -- -.S <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street ttt 300 West Oak Street 132 Sycamore Street 814 North "C" Sfree4l,,,++0O­ " <br /> Stockton, California Lodi, California Manteca, California T-racp r.C10for"n a <br /> Es-9 1a544&arwoo❑ <br />