Laserfiche WebLink
�I S APPLICATION FORISANITATION PERMIT Permit 5' <br /> (Complete in -Duplicate) <br /> Date Issued <br /> Ap <br /> Thiplication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> s application is made in compliance with County Ordinanc No. 549 <br /> P- <br /> JOB ADDRESS AND LOCATION_'____.-__ <br /> ' ! . <br /> Owner's Name- —------------------------ -------"--------------------------------------- <br /> --=-----------•------------- ------- Phone <br /> Address ------•--------- ' <br /> ---------------------------------------------- -•-•---------------------- ------- <br /> Contractor's Name <br /> --- -- ------------------------- --- Phone = <br /> Installation will serve: Residence E�Apartment House ❑ Commercial ❑ Trailer Court <br /> ❑ Motel ❑ Other ❑ , <br /> Number of living units:__ Number of bedrooms -. 3— Number of baths <br /> __ Lot size __� x-/- <br /> Water Supply. Public!s stem � m � "" <br /> } y ommuriity system ❑ Private ❑ Depth to)Water Table�i�,,Srft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe and an. <br /> Previous Application Made: Yes ( No i L�' p ❑ <br /> ❑ ® New Construction. Yes ❑ NoHA/VA: Yes [] No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: —_.. <br /> (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) <br /> t <br /> ti'c nki ( Distance from nearest wel!-----------------Distance from foundafionF------------------Material <br /> � No of compartments------------- <br /> ------------- ----_- - -----Liquid depth---r'~*-_ <br /> ------Capacity------------------- <br /> -fit # � <br /> Disposal Fi Distance_fromrnearest well/ -__ _Distance from foundation___/A---------Distance #o .nearest lot line---.r -"--- <br /> Number of fines_____ __. Length of each line----3�_'_________ kidth of trench_____- _ _ _r______________ <br /> Type of filter material__% � Depth of til#er material----- <br /> ����// A9 ,_}_/� Total leng#h--------6!--•---------------- <br /> Seepage it: Distance to nearest well /l -Distance m f undation___,�'_-Q_�_-.Distance to nearest lot _-_ <br /> Number of pits------ -------- --dining material-- __-Size: Diameter_-- ` ---- -Depth___--o ��----------------- <br /> Cesspool: Distance from nearest well___._____.---__-Distance from foundation__ 1^' _.Lining rriaterial_:______-._ <br /> ------------------------ <br /> ❑ Size: Diameter Depth -�/--------Liquid Capacity----------------- <br /> ---------gals. <br /> Privy: Distancefrom nearest well_____________________________"_---___ _❑ <br /> Distance,:to nearest lot lineDistance from nearest building------------------------------------------ <br /> ___ - --_-/__--------------- <br /> ---------------- <br /> Remodeling andfcr repairing (clescrilje):_____________________-------------------------------------- <br /> -----•------•-----•-------------------- <br /> -------------- ------------------------------------------------------- <br /> "- - --------- <br /> i <br /> = ------------------------------------------------------------ <br /> I <br /> �rt.k t Y 4—.i.w� 'Y�'-.WY4w��rem fir.,w.1M��.��w <br /> I arab rtify that-! have pared this application and that the work will be done in'accordance with San Joaquin County <br /> ordinances, t law ,'a d rul d regul tions of San Joaquin Local Health District. r <br /> 1t <br /> r <br /> __. }--- -- - ---------------- <br /> (Signed) <br /> - -- -- ------- - <br /> ,t -------- - ner and/or Contractor) <br /> By------------------------------------- <br /> --------------=--------(Title)----- r <br /> (Plot plan, showing size of lof, loc Ion of system in relafion wells, buildings, etc:, can be placed on reverse side). <br /> # t <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-------------_------------------------------------------ <br /> DATE <br /> ---------- ---------- - - __ DATE-------------- <br /> - - ----- ---------------------- ----------- �---------- - <br /> BUILDING PERMIT ISSUED = <br /> - --- - ---------------------------------------------------- DATE------ <br /> Alterations and/or recommendations_________________ _____ <br /> _ _ ____________________--_____-______-______________________-___________--._ _-­------------------------------------------------ <br /> ------------------------- <br /> __.__-_________•_ <br /> ww.r _.________"____ ------------------- <br /> -------------......�., .-, <br /> --------- ---------- <br /> --------- -- ---- - <br /> - <br /> ------------------------•-- <br /> ---------------------- ----- <br /> ----------------------------------------------------------- <br /> FINAL <br /> ----------------------- <br /> FINAL INSPECTION BY------------------------------- "- <br /> ----- -- ----- Date------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 1300 West Oak Street 132 Sycamore Street 814 North "C' Street <br /> Stockton, California Lodi, California Manteca, California. <br /> Tracy, California <br /> ES-9-2M , Revised 1-57 EP.M <br />