Laserfiche WebLink
APPLICATION FOR SANITATION PERMIT Permit No. _ ­,-- - <br /> Q (Complete in Duplicate) � <br /> Date Issued ..�_ IJr�L <br /> Applica ion is he y m the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This applicatio a in compliance with C unty Ordinance No. 549. <br /> ny ST' ' <br /> -77-- <br /> JOB A 55 AND LOCATIO ---�----- ------�--r--------�-�---------------------------- ---------- -------- <br /> � --- t <br /> Owner's Name------------- ------ •-� - - ----------•-----•------------------------------------------------------------------ Phone------------------------------------ <br /> Address---------------------------- <br /> -----------------------------------Address---------------------------- -- --------•-- ------------------------------------------------------------------------------------------------------------------------------------ <br /> Contractor's Name----------------------- -------------------------------------------------------------------------------------- Phone----------------------------------- <br /> Installation will serve: Residence-V\ Apartment House ❑ /Commercial ❑ Trailer Court E] Motel I-] Other ❑ <br /> Number of living units:- ___J___ Number of bedrooms ____C__ Number of baths _1___ Lot size -------`___~_4__X___ls ----------------------- <br /> Water Supply: Public system ❑ Community system '❑ Private ❑ Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand k Gravel ❑ Sandy Loam 0 Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ ^� <br /> Previous Application Made: Yes ❑ No New Construction: Yes No E]TYPE OF INSTALLATION AND SPECIFICATIONS: // 11 <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> -Jc�ZQ <br /> Se ti Tank- Distance from nearest well----�__O___Distance f'rF fo ndafien_____�_ --------Mater a!___ ______________________ <br /> No. of compartments--------~2_�--------Size__ �f--- _ - --Liquid depth <br /> ________ _�_ ____Capacity_.___ _Q-_ <br /> Dispa al.Field: Distance from nearest well-----7-�Distance from foundation --�_02_____Distance to nearest,lot line__.Q <br /> Number of lines__________:_,_�_j_ _____________ Length of each line--------�---0-- t1-Width of trench___ _�_ ___-_-____ 1 <br /> Type of filter materlal__, __��Depth of filter material_____e-------Total length_____----6-d_____________________ _ <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation____________-..____.Distance to nearest lot line----------------- <br /> ❑ Number of pits-----------•----------Lining material-----------------------Size: Diameter-----------------------Depth----------------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- <br /> El <br /> ___- _--___________-___-.-______- <br /> ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----- ---------------------gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ <br /> ElDistance to nearest lot line--------------------------------------------------------------------------------------------------------------------------------------------- <br /> Remodeling and/or repairing (describe):_____ <br /> j `� tea ------ ' J'�` ' = ---------- <br /> ______ <br /> _ <br /> :% ------ ----------- Z! ?�--------- ----------------------------------- <br /> � <br /> --------------------------- -------------------------------------------------- ------------------------------------------------------------------------------------------------------------- <br /> --------------------------------------------•------•--------------------------------------•--------------------------------------•-------------------------------------------------------------------------- <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 laws, a d rules and e,6ulations of the San Joaquin Local Health District. <br /> ------`�--- -------------- -•----- ---- <br /> (Signed) ----------------------------------- -----------------------------------------------------------------------(Owner and/or Contractor) <br /> By:-----------------------------------------------------------------------------------------------------------------------------------(Title)--------------------------------------------------------------- -�✓' <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can 6e placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----- -- ------- -------- ---- ------------------------------------------------------ DATE <br /> `� _ , � �.�..--- �-- -------------------- <br /> REVIEWED BY----------------------------------- <br /> ------------------------------------------------------------------------------- DATE.------- ---- ------------------------------------- <br /> BUILDING PERMIT ISSUED--------------------------------------------------------- __- ----- <br /> --- -------------------- DATE------------------------------------------------------------- <br /> Alterations and/or recommendations:--- =-- =--"'- - - d�✓--------------------------------- <br /> --------�f------------- <br /> ----------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------- <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> ---------. - ---------------------------•-------------------------/---------------------------•------------------------ <br /> FINAL INSPECTION BY------ ---------- ---- --------- -A_ f__. Date---------- ------- --- <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 8-51 Revised W-2100 <br />