Laserfiche WebLink
FOR OFFICE USE: - <br />---------------------- ------------------------ - Permit No. ._-! t <br />--------------------------------------------------------- <br /> APPLICATION FOR SANITATION PERM <br /> (Complete in Duplicate) <br /> ----.------------------- ti Date Issued .. <br /> __--.-_- This Permit Expires 1 Year From Date Issued X1d' <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the O1 7er©0-rod• <br /> This application is made in compliance with County Ordinance No. 549. <br /> -- �`' <br /> C- - ---------------�------------ <br /> JOB ADDRESS AND L CATION <br /> Phone •• <br /> Owner's Name Ph --------- --------•---------- <br /> AddressA, /-- ' �� ' �-- ------------ -------------------------------------------------------- -- ----------- <br /> Contractor's Name--- ----•------•-- Phone <br /> Installation will serve: Residence ❑ Apartment House [] Commercial 0 Trailer Court [IMotel ❑ Other I <br /> Number of living units: ........ Number of bedrooms -------- Number of baths __-}�-__ Lot size`__ _R '"''- --- ------ <br /> Water Supply: Public.system ❑ Community system ❑ Private Rj Depth to Wa'e"Table —6 - ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel E] Sandy Loam JE Clay Loam [3 Clay ❑ Adobe❑ Hardpan E] -4;*. ..- ...- t 41. <br /> f <br /> previous Application Made: {If yes,date-------- --]f No ® New Construction: Yes11g No E] FHA/VA: Yes E] No [I , <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: , i <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) {(�' <br /> t <br /> _-_-_-.-.Material-- <br /> Septic Tank: Distance from nearest well---�0-- __---Distarice from foundation__-. Q- -_-_.--___...- ______________________ <br /> No. of compartments----- 4� - t q p. ---=Capacity- f�----------- <br /> � vim- ----_Li Liquid de th----...�---_--_-- - <br /> Disposal Field: Distance from nearest well-. ®.-- -----Distance from"foundatio ___.--a .-___---.Distance to nearest lot ne----------------- <br /> fl <br /> Number of lines-----�•--- ---- ----------- --Length of each line---- �.------------------Width of trencb__-frencb__,�`V--- <br /> Number <br /> '. <br /> Type.of filter materia _��' ---Depth of filter material------- $_ ------Total length--- -1�------------------------------- 6 <br /> .. _ - ._ .-----_---- .-D.istance?from foundation----------------__-Ntance to nearesfi lot line----------------- 01 <br /> Seepage Pit: Distance to nearest well -• <br /> ❑ Number of pits.----- ------Lining material---- ------------------Size: Diameter----------------- -----Depth-------------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation-_.--------..-_---.Lining material--- ------------ <br /> El Size: Diameter--------------------------------------------Depth----- ----------------------------- ------Liquid Capacity----------------------------gal <br /> s`.' <br /> Privy: Distance from nearest well-------------------------------------------------Distance from"nearest°building--------------------------.------------ <br /> ❑ <br /> ---------------------- <br /> Distance to nearest lot line---- ------'----- ------------------------ ---------------•-----­---------- <br /> ----------- <br /> Remodeling and/or repairing (describe):----------------------------------- <br /> ---------------------------------------------------• ------------------------= <br /> -------------------------- <br /> ------------------------- ------------- <br /> 1 hereby certify that I have spaed reduWs lations olf the San JoaquinhLacalkHeall#heone in accordance with San Joaquin County <br /> ordinances, t and ru g District. <br /> --------..�----------------------(Owner and/or Contractor) <br /> k (Sign -- ----- - - ------- ------------------------------------- <br /> .. <br /> r t <br /> 1 le -----------------------=---------------•---------------------- <br /> - = (Title) <br /> Plot IBY - __ ----------------------------------- <br /> f. <br /> i.,._ <br /> ( pan,-showing siz of-lilt;location of,system �n gelation,to wells,,buildings, etc:;can be-placed on ererse-si a:= <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY____ �.�' <br /> DATE------- - ----------------------------------- <br /> REVIEWEDBY-------------------------------------------------------------- -------- ---------- --------------------------------------------- DATE----------------------------------------------------------- <br /> BUILDING PERMIT ISSUED-------------------------------- <br /> ----------------------------- <br /> DATE---------------------------------------------- ---- ---------- <br /> Alterations and/or recommendations------------------ - - --------------•--------------------------------------- <br /> ------ <br /> • n K ----------------- --------------------------- <br /> FINAL INSPECTION BY:-.--- . - .-.--- - Date.... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th street <br /> Sfoeklon,California <br /> Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 8-59 3M 3-'63 F.P-DD. -,-'tµ <br />