Laserfiche WebLink
Metadata
Document management portal powered by Laserfiche WebLink 9 © 1998-2015 Laserfiche. All rights reserved.
' r APPLICATION FOR SANITATION PERMIT Permit No. ._ tZ__•- <br /> ' (Complete in Duplicate) <br /> ` Data Issued _�` _ 5"+� <br /> Application is.h . y-made to fhe`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 /> JOB ADDRESS AND_'O _ ION.__- aZ_�_- - - <br /> / --------- <br /> ---------I—-----------•-------- -------------- <br /> Owner's Name_ ____. ' M <br /> •----•-----------•--•--•------ ------------ --------- -------- Phone—eq-7 <br /> Address_.._ -�__ ' �'_ ". ! <br /> s Name_ p ------------------------- <br /> Contractor <br /> r ------•-- Phone <br /> Installation will serve: j Residence ❑ <br /> Apartment House Commercial ❑ Trailer Court Motel ❑ Other <br /> Number of living units: Nuinber of bedrooms /__ Lot size _ Q x_ �p ❑ <br /> --- .�`____ Number of baths ._ _ ! <br /> Wafer Supply: Public-system Community system ❑ Private ❑ Depth to Water Table <br /> ,iv 1 <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ID Clay Loam ❑ Clay ❑ Ado b Hardpan ❑ <br /> Previous Application Made: Yes,❑ NoNew Construction; Yeses No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: / <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well-----------------Distance from foundation-----------------------------.Material----- ----------- -----------------------------• <br /> No. of compartments--------- ...........-----Size--------------------------------Liquid depth------------- --- -----Capacity._ <br /> is osal Fi t %. . <br /> p Distance from nearest weft__________________Distance from foundation__--______.______.Distance to nearest lot line------------------ <br /> Number of lines-----------------------------------Length of each line___--------------- , <br /> ----------Width of trench. '�' <br /> Type of filter material-------------------------Depth of filter material- Total length------------------------------- <br /> See Pi : Distance to nearest weld----Di f�amfdation__� � Dis�nce to nearest lotlineNumber of pits------/--- _ ------Lining material .Size: Diameter--- ------------- <br /> ---Depth # l <br /> Cesspool: Distance from nearest well__ _Distance from foundation__________________ <br /> Lining material----------------------------- 4 <br /> ❑ Size: Diamefer----- - ---------- -------------------Depth-:--------------------------------------------------Liquid Capacity--------------------------__gals. <br /> Privy: Distance from nearest well------------------------------- -------------------- <br /> Distance from nearest building_�_.______--.________.___._ <br /> Distance to nearest lot line__.______ ------ <br /> - ------------ <br /> Remodelin a /or repairing (describe):__-'____-_ <br /> - s ------------•---• �. <br /> -• -- v <br /> ----------- --------------- - -- -------- -4- <br /> 7 <br /> ------------------------------------------------------------------------- <br /> ----------------------------------------------------- <br /> ------ -- <br /> -------------------------------------- ----•------ - -----------------•---- ----- at the work will be-done in accordance w= - <br /> hereby certify that l have prepared this applicati n and }hith San Joaquin County <br /> ordinances, State and r s d regula ' of the San Joaquin Local Health District. <br /> (Signed)..---------- -- . <br /> -- -- --------------------- -------------------------------------------------------- <br /> Owner and o Contractor) <br /> By:--------------------_--- --- -- -•_----- -- - - (Title ___ <br /> - -- - - ------- <br /> (Plot plan, showing ' e of lot, location of system in relation to wells, buildings, etc., can be <br /> 9 p on rover side <br /> FOR EPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY <br /> -------------- DATE-------- ------------------------ -----6-----f- --------- <br /> REVIEWED BY--••------••----------•------------ - <br /> UILDING PERMIT ISS�IED <br /> -------------- ------ DATE <br /> --------------•-•-------------------- --•-------- DATE----------------- --------Alterations and/or recommendations:__...________..__.___ <br /> -----------------•- <br /> .._ <br /> ''U�G <br /> FINAL INSPECTION BY_ _- <br /> �---- ----------- ------------------ <br /> SAN <br /> L <br /> Date-- ----------- ---- - ---- - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street <br /> 914 North "C" Street <br /> Stockton, California Lodi, California Manteca, California <br /> • Tracy, California <br /> 'ES-4-2M 10-52 Revised W-2100 <br />