Laserfiche WebLink
APPLICATION FOR SANITATION PERMIT Permit No _-IJe�Q-.7 ___.. <br /> (Complete in Duplicate) <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 compliance with County Ordinance No. 549 <br /> JOB ADDRESS AND LOCATION----A.. ----/-------------r5c------ `----- --------•------------------------------ <br /> Owner's Name---�-fid-�- - --�---- ------------•----•------------------- - - - --------------------- ------- Phone- --------------------------------- <br /> Address------ri*^ '{� ,+- <br /> Contractor's Name.--- -_-- _ -- Phon :_5•ni_l�-_�_�__- <br /> Installation will serve: Residence &—ArrTm—ent House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: J----- Number of bedrooms - -. Number of baths --#---_ Lot size ----6-a------ -------------------- <br /> Water Supply: Public system ommunity system ❑ private ❑ Depth to Water Table _4r ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [ c pan ❑ <br /> Previous Application Made: Yes ❑ No CI-New Construction: Yes ❑ No CL-1 <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--------------------------Size--------------------------------Liquid depth-----------------------.-Capacity-------------------- <br /> isposal Field: Distance from nearest well---- -,. ........Distance from foundation--------------------Distance to nearest lot line----------------- <br /> . • r Number of lines-----------------------------------Length of each line------------------------------Width of french----------------------------------- <br /> OF Type of filter material-------------------------Depth of filter material--_----.-----. ------ length---.------._---------.----------__- <br /> Seepage Pit: Distance to nearest well----------------------Distance f m foundation-__-- <br /> � �<�_ .-_�-Distance to nearest lot line--./��-_--_ <br /> ��- Number of pits---_-- -------------Linin material_-,( -.Size: Diameter,t�,_'..-_- .---Depth-­2.�`f <br /> Lining <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- <br /> El Size: Diameter------ ----------------------- -------Depth---------------------------- ---------------------Liquid Capacity. --------------------------gals. <br /> Privy: Distance from nearest well---------. -------------------------- ---------.-Distance from nearest building-------------------------- V <br /> ❑ Distance to nearest lot line. ------------------------------------------------------- <br /> Remodeling and/or repairing (describe)--------------------------------------------------------------------------------------------------------- ----------- <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 ules and regulations of the San Joaquin Local Health District. <br /> c <br /> (Signed) G1j(�� - - ------- --- -------- ---- ---- ----------------------------- ---------- ------------------------------ -Contractor) <br /> By_ .. ..... ... . 4-9104-01------------------------- --------------------------------------- -----(Title)-- eye '"'� <br /> (Piot 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--5-----------•----- ! <br /> REVIEWEDBY -S'-- - - ----- --------------- - --------- -------- -------- ------------- -------- DATE--- ---------•- <br /> BUILDING PERMIT ISSUED--------------------------------- --------- ----.- DATE. V <br /> Alterations and/or recommendations------------------------------------------ ----------------------------------------------------------------------------- ---------- <br /> ------------------------------------------------------- ---------------------- -------------------------------------------------------------------------------------------------•--•----------- ---------------------------- <br /> , <br /> -----------------------•----------------------------------- ----------------------------------••-------------------------------------------------------------------------------------------------•--------- <br /> 4- /.4,�-- •cs— <br /> FINAL INSPECTION BY:- ( --------------- -- ---------- - 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—.3-2M 145446 ATWOO6 i2-sn ' <br />