Laserfiche WebLink
J _ <br /> APPLICATION FOR SANITATION PERMIT Peftr,.:t_No. ..1�...4?.. <br /> (Complete in Duplicate) a? �SY <br /> - Date Issued/_�__. .__. <br /> 1 <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 compliances with County taoinan.Le No. 519. <br /> JOB ADDRESS ND CATIO1 / ----------------------------------------------------------------------..;a. <br /> Owner's Nam --- ------------ -- -- --- ---,-- ------•-------------------------------------- ------------------------------------ Phone-_k-----1-51�--7- ---------- <br /> Address----------- -- ------ --- ----q----- --------------- ----- --------------------------------------------------------.................................................................................. <br /> Contractor's Name----- -•------------------------------------------------------------------------------------------------------------------------------------ Phone----------------------------------- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Mot,1l ❑ ?Otther.❑ <br /> Number of living units: _.1--- umber of bedrooms _-Z Number of baths _�_.__ Lot size _--/--�.�'-....(# ______________________._ <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand Fl Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe�rclpan ❑ <br /> Previous Application Made: Yes ❑ No oo" New Construction: Yes No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet. I <br /> Se tic ank: Distance from nearest well..*--_-----. Distjc fr �un t-on----�-_ _.--.--.-.Mat rial--- <br /> ---- --------- - ---- --- -------- - <br /> p No. of compartments-..--....-_X---..-.-.Size_sa?_ _ __.._ _�Liquidfdepth_..-._ _�-___.-__.-._Capacity___ <br /> Disposal ield: Distance from nearest well._ '_�_Lengfh <br /> Distance from foundation/ -__.Distance to nearest lot line__ �.- <br /> tt <br /> Number of lines__________ ______ of each line---------_. _. Width of trench..-.--.---.- l� _ .. -------- <br /> Type <br /> - "�1 <br /> Type or' filter materia / p -. g <br /> `_.._ th of filter material-_-....1 ..---.-Total length ................... <br /> --- <br /> Seepage Pit: Distance to nearest well------ <br /> - <br /> ---------------Distance from foundation--___-------__-.-.-.Distance to nearest lot line__.-.__.-.._----- J <br /> ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth------------------ -------------- ( A <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 /> Re delin d/or repairing( scr' e):�---- -------------------- -------------------------------------------•-------•------------------•-•-- <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, and rules and regulations of the San Joaquin Local Health District. <br /> r <br /> `- +_.__-.._._-...___..-__.._...._.--_.-_-._.__-_--...._.__.-.--...._._.__.._...._-.-.__(Owner and/or Contractor)______ <br /> By:------------------------------------------------------------------------------------- ----------------------------------------------(Title)-------------------------------------------------------------- <br /> (Plot 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 /> BY DATE----0 <br /> �• <br /> BUILDINGPERMIT ISSUED ---------- --------------------------------------------•--------------------------------------- DATE----------N-------------------------------------------- <br /> Alterationsand/or recommendations--------------------------------------------------------------------•------------------ --------------------- -••--•-- -----------------•- <br /> ---------------------------•--------------------------------•---•-----------------------------------------------------------------------------------------------------------------------------•-•--•---------------•------ <br /> ---------------------------------------------------------------------------------------------•------------------------------------------•-••-•---------•----••---------------•----------------------------------.-•_...... <br /> ------------------------------------------------------------------•--------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ---------------- ------------------------------------------------- ---- ------------------­------------- ----- ----- ----- ------------------------- -----------_......-- <br /> FINAL INSPECTION BY:•.----4V--------------------------------------------------------- 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 10-52 Revised W-2100 <br />