Laserfiche WebLink
1 APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) ` <br /> Date Issued ' <br /> Applica+ion is hereby made t the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in c oP pliance with County Ordinance No, 549, <br /> # ----_-----------:----- - <br /> JOB ADDRESS AND LOCATION - ` - 1��_ <br /> Owner's Na - -"----•-----------------•------ ----------------------------------------- Phone----------------------------------- <br /> -------------------------- <br /> ---------------------- <br /> Address : .°� ••r-{ � '----------- ------------ <br /> Contractor's Name--- 'L,�• Phone----------------------------------- <br /> Installation will serve: Resid1ce [Apartment House Commercial ❑ Trailer Court ❑ Mot I ❑ Other <br /> hl �x <br /> Number of Irving unitsll__ ____ Number of bedrooms _ ._ Number baths __f-.__ Lot size _ ____-______. __ _�. _.._-__... <br /> Water Supply: Public systek ❑ Community system ❑ Private Depth to Water Table -------- ft. <br /> Character of soil to a de +h of 3 feet. Sand Gravel Sand Loam Clay Loam Clay Adobe Hardpan p ❑ k ❑ Y ❑ Y ❑ Y ❑ # p ❑ <br /> Previous Application Made: es ❑ No ❑ New Construction: Yes ❑ No ❑-1 - � I i pu' <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: I4 t. , <br /> No septic tank or cess ool permitted if pubic sewer 's available within 200 feet. <br /> Septic 'ank: Distance rom nearest well�,��.________Distance fro., foundatiod-0_ ...____.Maters l_ Y <br /> IIS / <br /> p k , Y , ------Liquid depth-- ------------ ,-------Capacity-----�= ----- 4 <br /> No. of compartments . >_______Siz �..--- -- '� <br /> III +� <br /> Dispos4l Field: Distance-from nearest welh_- ~_._�.._Distance from foundation_,__{_ __.__ -Distance to nearest lot lin a__ <br /> Number 1of lines__________ ____ Length of each line__________€ __ . + I_ <br /> r _Width of'trench-------_X/-- ___-� --------__- <br /> Type of filter materi3�C ' '! !Depth of filter material_._.___ ._ ---------Total ,length___.____.______ __ _______________ <br /> SeepePit: Distance to nearest well----------------------Distance from foundation___....._...__=----Dista e to nearest lot line----------------- <br /> Seepage IIS <br /> ❑ Dumber of pits----------------------Lining material----------.------------Size: Diameter-----------,'-----'------Depth-_.------------------------------ <br /> 00Ip <br /> Cesspool: Distance111from nearest well-----------------Distance from foundation._.- Lining-material------------------------------.------- 0 <br /> ❑ Size: Diameter--------------------------------------Depth-----------------------------------------------?_-Liquid Capacity----------------------------gals. <br /> .............Distancesfrom nearest building-------------------------.-__ -_ <br /> Privy: Distance from nearest well------------------------------------ - ---------- rn <br /> ❑ Distance �o nearest lot line----------------------- ------------------------•----------------------=---------------- <br /> --------------------------------------------------- <br /> Remodeling <br /> --------------------------------------Remodeling and/or repairing (describe):------------------------------------------------------- ---•-----------......-------------•-_-------------------------------------------------------- <br /> ------------•-----­---------------------­---- i-------------------------------------------------------------------------------- -------------•----•---------- --------------------- <br /> -------------------------------------- <br /> -------------------------------------------------- ----•---------------------------------------------------------•--------•-------------------------------------- --------------------------------------------------------- <br /> ------------------------------- -------------- --------------------------------------------------------------------------------------------------------------------------- i-----------I-------------------------- <br /> 1 hereby certify that I have prepared this application and that +he work will be done in accordance with San:Joaquin County <br /> ordinances, State laws, and rules and regulations of t e San Joaquin Local Health District. I { <br /> (Si ned � ��_'"`C^. � ----------- ------------------------------------ <br /> g - (Owner and/or Contractors <br /> Sy=-------------------------------a�--•---.--------------------------------------------------------------------------------------------(Title)------------------------------------- •----- ----•-- -------- <br /> (Plot plan, showing size of lojf� location of system in relation to wells, buildings, etc., can be,placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY ------- --------------- ------ ------------------ ------------------------ --- RATE-�- -"-------------------------------------------------- <br /> REVIEWED BY------- -------------- --- DATE_ --------------------------------------------- <br /> BUILDING PERMIT ISSUED--i-------------------------------------------------------------------------------------------------- DATE----- --- <br /> Alterations and/or recommendations------------------------------------------------------------------------------------------- <br /> _-•• <br /> --------•-------------------------- ----------------•-------------------------------- --------------------------------•--------------------------•-•-•---------------------- - � � <br /> �h <br /> -----------•--------------- ---•---- ---------•----------------------------------------• ---- ------------------------------------------- <br /> FINAL INSPECTION BY:_1 --------------------------�r_��__--- � ----- Date --------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 1 300 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-21010 <br />