Laserfiche WebLink
V\7 ` APPLICATION FOR SANITATION PERMIT Permit No. ..,�.y---y, .. <br /> r ` (Complete in Duplicate) �p <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 compliances wWiith County Ordin ce No. 54 <br /> JOB ADDRESS A LO ATION..... - ---�- --- -- - - ---- --- - ---... <br /> Owner's Name -------------- - ----------------------- Phone <br /> Address ....... --- ------ ----.------ ----- --- ---- ------------------ ---------------- <br /> - -------- <br /> -- -------•---- ---------------------- <br /> --- ----- - ------- <br /> Contractor's Name__._ - -t.r!'....___ Phone/�._U__:_Z.Lr.l_.y. <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -_(---- Number of bedrooms g_. Number of baths . ___.__ Lot size -__--1.�-. 2 .� "- <br /> 1 -- --- ---- - ---------- ----------------- <br /> Water Supply: Public system ❑ Community system ❑ Private j��eFSfh tb Water TableVY. it. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ <br /> Previous Application Made: Yes ❑ No 04­11evJ Construction: Yes <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <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---------Z Size__ j--- Liquid depth _:______ _..L Capacity ~G...... <br /> r e'L----- <br /> Disposal Field: Distance from nearest wel�*.._._._Distance from foundation..../.S-_ .....Dis ance to nearest lot line..-1.1,x...... <br /> Number of lines........ --------------Length of each line.......J�.'?l._^..�...Width of trench:_.2__ ..'...._..______... <br /> Type of filter materiaL_j. ----------Depth of filter material__./_S7.____._.Total length--_- ......................... <br /> i <br /> Seepage Pit: Distance to nearest well-..���- _Distance rom.fo}y ndation....r� ---...Distance to nearest lot line-A5--------- <br /> Number of pits-._-_ _ Lining material_ '1rt?�'!.__.Size: DiameterO.-J............-_Depth--.1"_A,--_____---- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation._.--------------._.Lining material______-_-.__-____._-___-.------------. <br /> ❑ Size: Diameter----------------- --------------------Depth----------------------------------------------------Liquid Capacity............................gals. 4 <br /> Privy: Distance from nearest well----------------------------------------------.__Distance from nearest building______;_-_-_-_.--._--___-----_-__.____-_. <br /> ❑ Distance to nearest lot line-------------------------------------------------------------------------------------------------------------------------------------------- <br /> Remodeling and/or repairing (describe):------- -------------------------------•-------------•---------•----•-----------------•---------•--•--------•----------------••------•.----•--•--•-•---• <br /> .............................................----............................................................................................. ------•-•-----------•••--•-------------•-------•--•...................... <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 les and regulations of he San Joaquin Local Health District. <br /> (Signed)----- . •. ---•-•------• - ------ - --- --- ------------ -- -------- ----- --------------------- Contractor) <br /> t7 <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 /> REVIEWED BY------------------------------------------- ------ 1 --- ----------- DATE-------- <br /> BUILDINGPERMIT ISSUED.----•------------------------- ------------------------------------------------------------------- DATE...... <br /> Alterations and/or recommendations:-------- ...\ <br /> -• ------------------------------------------------------------------------- -- ----------- _...... <br /> - ----------------•------- <br /> -------------------------------------------------------------------- -------------------•----------------- -•------•------ <br /> -----------------------------------------------------------------•---- -•---------------------------------------•-----------------------------------------------------................................................ <br /> ----------- ---------------------------------------------------------------------- -------------------------------------------- •-----------------•---•------------•--_.._......---------..._..-----------•--------•----•-- <br /> FINAL INSPECTION „ Date----- Z.----- � �� <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 145446 ATWOOD 12-54 <br />