Laserfiche WebLink
APPLICATION FOR SANITATION PERMIT Permit No. _222 <br /> PornPjefe in Duplicate) <br /> Date Issued <br /> A <br /> This <br /> is hereby made to the Son Joaquin Local Health District for a Permit to construct and install the work herein described. <br /> is application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION <br /> ----- ------ ------- <br /> Owner's Name---- e e,,`/ 5- .. ........ --------- --------------7---------------------------------------- <br /> -------- - <br /> --------------------------------:--------I------------------------------------------ Phone-------- <br /> Address---------- <br /> ----i --------- <br /> 2 ------- -----------------------*-------------------------------------------- --••--------- <br /> --*---------•--------------------------------------------------------------------- <br /> Contractor's ----- --_4-- ------------------------------------------------ ---------_----------- Phone <br /> Installation will serve: Residence Apartment House El Commercial E3 Trailer- Court E] Motel Ej Other F-] <br /> Number of living units: .-./- Number of bedrooms ----2,Number of-baths -__1_. Lot size ---- <br /> Water Supply: Public system �ommunity system ❑ Private te El Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet:' Sand E] Gravel E] Sandy Loam E] C.lay Loam El Clay C1 Adobe 0—Hardpan El <br /> Previous Application Made: Yes El No 8-'--New Construction: Yes D- No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or-cesspool permitted if-public sewer J*ajIa6Id-­w"jthih'200 feet.) <br /> Septic Tank:,,,j, Distance from,nearest well e" from foundati6n--------------------Material <br /> ----- -----------Disfanc <br /> F1 'No. of compartments--------- ------------------------------ <br /> ----------- Size--------------------------------liquid depth--------------------------Capacity-. <br /> --------------------- <br /> Disposal Field: Distanc6 from nearest well <br /> 11 ,C*,Wr3l' d;��Iu'mber 'o�f lines------# .................Distance from foundation--------------------Distance to nearest lot line-_________--__. <br /> ----------­-----------------Length of each line-------------- <br /> -- ------------Width- of trench------ <br /> Type oT_fijIfe`r7n._afe_r1al-------------------------Depth of filter material-t---------------------Total length------- -------------- <br /> -------------------------------- <br /> — <br /> Seepage Pit: Distance to nearest w, Vh-"V_��_Distance from foundation_.____40_/.Disfance to nearest lot line---J <br /> Number of pit s_'1 <br /> ------------Lining mat Size' Diameter___.. ------------Depth I I - ------------- <br /> Cesspool: Distance from nearest well--'- <br /> El Size: Diameter--- ----------------Distance from foundation --- ---------- -. Lining material--------- <br /> --------------- ------&.... ... -Depth Liquid Capacity----------------------------------- -------------- Lining <br /> ----------------------------- <br /> ' i _ - ----------------------------gals. <br /> Privy: Distance from nearest <br /> ----- ---- <br /> F1 Distance 'to nearest lot line_-__---. I _--------- ---Disfancei 'from nearest buildin <br /> ------------ <br /> g------------------------------------------- <br /> -----------k----------I------ <br /> ---------------- ----------- ---------P"----------------------------------- <br /> Remodelin <br /> -----------------------------------Remodeling and/or repairing (describe):-'— A-13 1,ZAY L <br /> . -_ -_ -- ----------------------- ...... <br /> --------------------------------------F --------- -------------- ---------------- ........ <br /> -------------------------------------------------­------------------------ <br /> FIli ---------------------­_�------------------r------------- ------------------ ----------------------- <br /> ---------------------------------------------------------------- --------- -- <br /> -------­------------------------------------------------------------ <br /> ------------------------------- ---- i -- I——------ ------------I---------­-------------1___------------ <br /> I----------------------------------------------------------- -----------------_---------------------_--I--------------------------------------------------------------------- <br /> I hereby certify that'I have prepared f his,a p"plicaf ton-and-that-the-work will-6e done in accordance with San Joaquin County <br /> ordinances, State s, and rules and regulations of.fhe San Joaquin Local Health District. <br /> {Signed}.-------- --- --------------------- --- ---------------- ---------------------------------------------------------------------- (0 and/or Contractor)' <br /> .By:--,.. <br /> --- --- ---- - --------------------------------------------------------JTitle)---------- -"- -n <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 /> REVIEWEDBY-------------- -------------- --------------------------------- <br /> ---------------------- -------------------------------------- DATE-------- <br /> BUILDING ----------- <br /> BUILDING PERMIT ISSUED ------------------------------ <br /> Alterations and/or recommendations____________________ - ---------------------------*---------------------------- DATE-------------_ <br /> TE------------- ------------------------ <br /> ---- ---- ------ -------------- ---------------------------------- ----------- --- <br /> ---- ----------- - <br /> --------- <br /> -------------------------- ---------;'r ------------__ ----- -------------\-, <br /> ----------- ------- <br /> ---------------------- --------- - ------------------------------------------------------------------------------------------------------- ......... <br /> _AA--- I—------ ---- --------- �_ —-------------------------------------------------------------------------------------------- <br /> --------------:---------- -------------------------------------------------------------------------------------------------- <br /> ------------------------------------ <br /> ---------------­\', -------------------- <br /> - ------------------------------ --------------- ------------------------I------------ ------------------------------------------------------------I--------- ---------------------- <br /> FINAL INSPECTION BY______________ --------------------- ------------- Date-- ----------•----------- - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 Waif Oak Street 132 Sycamore Street 014 North "C" Street <br /> Stockfopi, California Lodi, California Manteca, California Tracy, California <br /> 145446 ATWOnD 12-54 <br />