Laserfiche WebLink
Metadata
Document management portal powered by Laserfiche WebLink 9 © 1998-2015 Laserfiche. All rights reserved.
f APPLICATION FOR SANITATION PERMIT Permit No. -___---1- .. ___ <br /> (Complete in Duplicate) <br /> �._ Date Issued ---•-__------ - <br /> Applica*ion 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 /> JOB ADDRESS AND LOC TION--- -�_ _ -------- + ---- �- <br /> Owner's Name---l " ----- ---------------------------------------------—.----------------=----=--- ------------- Phone---------------------. - <br /> Address "_Pl - -------- -----`------ -`--- ----------------- ----------------------------------------- -------- <br /> Contractor's Name - - ------ -•---- y.�`` '(�' <br /> -- I __ Phon <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: Number of bedrooms --� Number of baths Y----- Lot size ___�.4 -___-I�_ 9 "____________________ <br /> Water Supply: Public system ommunity system C] Private ❑- Depth"to Water Table C12 ft. " <br /> Character of soil to a depth'of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe k0OH00ardpan ❑ <br /> Previous Application Made: Yes ❑ No New Construction: Yes ❑ No rq_ <br /> a _ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: 4 <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 /> Disposal Field: Distance from nearest well_________________Distance from foundation------ ° Distance to nearest lot line_________________ <br /> Number-of lines------°-----------------------------Length of each line------------------------------Width of trench----------------------------------- <br /> Type of filter material--------_----------------Depth-of filter material----____-________?-----Total length-------------------------------..--___--._ <br /> Seepage Pit: Distance to nearest well_0?%4h^.k .___Distance from foundation.....tSr _-..Distance to nearest lot line_-..FA _____ <br /> [ ....,� Number of pits_-- ----------Lining material---IQr9 ___-Sixes Diameter_.3 `�_-.__--Depth_____°_________________ <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------ .. <br /> ❑ Size. Diameter--------------------------------------Depth---------------------------- :----- --------- ---Liquid Capacity---------------------==---gals. <br /> Privy:' Distance from nearest well----------------------------------:--------------Distance from nearest building----------------------•---------- <br /> --------. <br /> ❑ Distance to nearest lot-line---------------------- - - <br /> ------------------------------------------------------------------------------------------------------- €€ <br /> Remodeling and/or repairing (describe):--------- ------------------------------------------------------------------------ f <br /> -------•-•----•--------------------------------------------------------------------------------- <br /> ------------------------- <br /> ------------------------------------- -------------------------- --------- -------------••-----------------------------•-----•-•------------•-----------------------------------------------------------------........... i <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, and rules and regulations of the San Joaquin Local Health District. <br /> -- <br /> (Signed)--•--••-- ---- --- - - --- - --- -�-- --- ------------- . - --------------- -------•------------------------- -C�rvner�d/or Contractor] , <br /> sr• � ' •• ----------------- (rile} <br /> ----- <br /> plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--------------------------------------------- DATE -------------- <br /> a <br /> REVIEWED BY ------------------------ <br /> ----------------------------------- ------------------------------------------ DATE---------•------------------------ <br /> BUILDING PERMIT ISSUED._.-_-•-- -------=-----=---------------- ;------------------ DATE <br /> Alterationsand/or-recommendations---------------------------------------------------.......................................................... •-----•------------------------------•-•-••-•--- <br /> --------------------------------------------------- ----------------------------------------------------- •-------------------------------•----•---------- <br /> --•------------------------------------------------------------------------------•------------------------------------------------------------------------•-•-•------ •----------------------------- .-•--------------- <br /> ------------------------------------------------------•-------------------------------------------------------------------- -------------------- ... --------------------------------••----•-------------------------� <br /> FINAL INSPECTION $Y:- qV------------ Date-------------------------------------------------------- <br /> SAN <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 ; Revised W-2100 <br />