Laserfiche WebLink
\,�e W-�. . <br /> APPLICATION FOR SANITATION PERMIT Permit No. <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----------• ,0.9-04--------•-C-----•-� r-d------------------------ ------ <br /> �~ - ----------------------------------------------- <br /> Owner's Name------------------ --------- 7- li-"-•5-,e-- ----------------------------------------------------- ----- Phone------------------------------------ <br /> Address <br /> --------------------- <br /> ----•-------- <br /> Address---------------------------•-----4--- ..3--,5-- -------- ------- -- -------- ---- -- <br /> ---------- - -----:------------------------------------------------- <br /> V7/C . .. - ----------- <br /> '' -A <br /> ontractor's Name........ ....... � -------------------- -- - ----------------------------------- <br /> Installation will serve: Residence �i artment House ❑ Commercial ❑ Trailer Court ❑ Motel [4 Other Q <br /> Number of living units:/------ Number of bedrooms -A_ Number of baths ----f-- Lot size ------.--fo---3,�-_--f� �-______-_:_--___.____ <br /> Water Supply: Public system . Community system E] Private E] Depth to Water Table -------- ft. f <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> Previous Application Made: Yes [ o❑ 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.) <br /> Septic Tank: Distance from nearest weil--,41�"h.�Distance from foundation-_--_/�P�::.Materiai--___ �-..__--_- -- <br /> No: of compartments.----------_-2-------Size--- ---Liquid depth...------ .O----------Capacity---,e00V-- 04 <br /> Disposal Field: Distance from nearest well.A.-A- .XC Distance from foundation_._1_u__ !___-. istance to nearest lot line------- <br /> Number of lines--------------�_-_-__-.-. -_--.__-Length of each line----_-_--7�-_._-_-__...Width of trench------.- _`............. <br /> _. <br /> Type of filter material---5'—'77 ._DEpth of filter material... ---.Total length_-_?_1$::'1------------------------- <br /> -� <br /> Seepage Pit: Distance to nearest well....fl � .-Distance frgm foundation----M--_----..Distance to nearest lot line--------------t- <br /> Number of pits....____._.________ 7�Lining material_ ✓ --..Size: Diameter-__-.-- :------- Depth------ ,$...... <br /> Cesspool: Distance from nearest well--------------___Distance from foundation................... Lining material--------------------------- <br /> Size: Diameter------------- ---.De th----:-------.--- __.-Li Liquid Capacity <br /> ❑ - P --------------------- --------- q ---------------••--------•--gals. <br /> Privy: Distance from nearest well-_----------------------------------------------Distance from nearest building---:-------_.-----------__-.:---._---_-.-. <br /> ❑ Distance to nearest lot line--------------- . <br /> • r <br /> Remodeling and/or repairing (describe)-------------------------------------- ----------•-•-•---•----------------------.----------------------------- •- <br /> ----------------------------------------------------------------------------------- ----------------------------r-------•------------------------------- ----- -----------------------------•--------------------------;---- <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 /> (Signed).............. �eof <br /> c �J or Contractor) <br /> itleJ. <br /> (Plot plan, showing st, to ation of system in relation to wells, buildings, etc.,'can be placed on reverse side). / <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED SY---V -------- DATE'--_------ <br /> -------- ---------•--------------------REVIEWED BY---------------------- -------- ---------------------------- --------------------------------- DATE---=---------------.---------------­------------- ............. <br /> BUILDING PERMIT ISSUED------------•----------------------- ----------------------- •----------- DATE----- <br /> Alterations and/or recommendations:---------------------------- ------------------------------------------------- <br /> ----------- <br /> ------------------------------- -------- -- -- - --------- <br /> ------------------------------------------------------------------------ --------- <br /> f.. <br /> '" ` --------------- - -------------. -.....---------------------------------------------------------------------------••------------------------------------- <br /> -----•-------------------- /I------------------•-- ---- - ---- ------ --- ----------------•--•------- ---------- <br /> - ------------------------------------------------------------------------------------------------ -- ------------------ - - <br /> - Date --- <br /> FINAL INSPECTION 'BY:................... .. / � `�� <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 />