Laserfiche WebLink
FOR OFFICE USE: AI&I <br /> J------------ l� &-YI , <br /> --------- ------------------------- APPLICATION FOR SANITATION PERMIT Permit <br /> ------------------------------------------------------ (Complete in Duplicate) <br /> Date Issued <br /> ------------------------------------ - --_--------- _ _ This Permit Expires 1 Year From Date Issued <br /> Application 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. S49. <br /> JOBADDRESS AN�D,,LOTION - - s---------- --------------------- - ---------------------------------------------------------------------- <br /> Owner's Name -- ------ ----_---- Phone-_71 <br /> Address--- -------- ------- <br /> e � <br /> Contractor's Name-------------------- - --- I. ---- •----- ' Phone <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _/-_ Number of bedrooms _c:2- Number of baths -elLot size __+`__U__� _ _ --___________________ <br /> Water Supply: Public system [Community system ❑ Private-❑ Depth to Water Table 4-� ft. <br /> Character of soil to a depth of 3 feet: Sand ❑- Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[Hardpan ❑ <br /> Previous Application Made: (If yes,date----------- ) No ❑ New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic fank'or cesspool permitted if public sewer is available within 200 feet.) <br /> �eP is Tank: Distance from nearest well_.-___--__-__Distance from foundation____________________Material_________________._____________-__...___-__. �\ <br /> A No. of compartments--------------------------Size-------------------------------Liquid depth------------ ------------ Capacity------------------ <br /> 10 1 Disposa7Field: Distance from.nearest welL� Distance from foundation./�_�_______.Distance to nearest lot ling,__% .-__.__ <br /> Number of lines--------/--_._-_--. Length of each line____--5--&______`_____.Width of trench___.c��--------------------- <br /> Type of filter material_15r_�QA:_�__Depth of filter material---�8_-_-._----.Total length--_-_--574/------------------------- <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------:Distance to nearest lot line------------------ <br /> 171 Number of pits----------------------Lining material----------.---.--------Size: Diameter---*..................Deptb_------------------------- <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 /> ❑ Distance to nearest lot line-- ----------------------------- -- -- ------ ----------------------------------------------------------------- -------------------- <br /> Remodeling and/or repairing (describe):__.._ _. ._._-____.5--v_s_______ ____________ <br /> -------•-----------------------------------------•---------------------------------------------------------------- - --------- -------------------- <br /> ----- .... <br /> ---------------------------------- <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> I hereby certify that 1 have prepared this application'and that the work will be done in accordance wifh San Joaquin County <br /> ordinances, State laws; and rules and regulations of the San Joa uin Local Health District. <br /> (Signed)---- ------------------------ ------.----- ---(Owner and/or Contractor) <br /> By:------------- -- { <br /> Title <br /> ' ].. <br /> (Plot plan, showing size of lot, location of system in relation t wells, buil Ings, etc., can be placed on reverse side). <br /> /ice FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED B}! / - - ------ - -- ---- DATE__/0Q Z' r° <br /> REVIEWEDBY------------------------------------------------------------------------------ ------------------------------------------- DATE------------------------------ ---------------........ <br /> BUILDING PERMIT ISSUED------------------------------------------------------------•---------------------------------------- DATE----------------------------------------------------------- <br /> Alterations and/or recommendations:---------- ------ - ------ ------ -------------------------------------------------------------------------------------------------------------- <br /> ----------------------------------------------------------------------- ---------•-------------- -•-------------------------------------------------------------------------- ----------------------------------------------- <br /> --------------------------------=-------- ----------------------------------------- -------------------------------------------- ---------------- --------- ------------------------------------------------------------------ <br /> FINAL. INSPECTION BZ----- ----- ----- -------- Date._.//.v`� �'7---------- --- ------- -- ------ --------------- <br /> SAN J UIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br />