Laserfiche WebLink
li�v,o . ,PLICATION FOR SANITATION PEkrd1T, <br /> Permit No. ...A.�.�!-3..--- <br /> (Complete in Duplicate) <br /> Date Issued .-.........�.�! <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install th work herein described. <br /> This application is made in compliance with County Ordinance No. 549. z5- �� <br /> JOB ADDRESS AND LOCATION....P�7� <br /> -- -- / ------- <br /> �' .--- ------ ---_-- Phone.'-........... --'-----'....... <br /> Owner's Name-�-./..- ---`... --Address--'---a� ......•---' - ` ------------------------------ ----------'---------------------.-------------'...... <br /> Contractor's Name...... o !fir----- ------------------------------- Phone.�..4a.f;PVA1. <br /> Installation will serve: Residence gL Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: Number of bedrooms -------- Number of baths .�.-Lot size --- .. .. ---- <br /> Water Supply: Public system ❑ Community system ❑ Private ❑ Depth.to Water Table 0 v0t. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> Previous Application Made: Yes ❑ No ❑ New Construction: Yes gd__No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> I <br /> Septic Tank: Distance from nearest well..-,;70---..Distance from found Ion....�a--------Mater�.-- ----G- -- --------------------------- <br /> No. of compartments..._ ...... .....Size.. -} 6...*Aiquid depth- .__----- ---Capacity.-,.ZZtA... , <br /> Disposal Field: Distance from nearest well .Distance from foundation....................Distance to nearest lot line................. <br /> ❑ Number of lines..............._-------_---.._..Length of each line------------------------------Width of trench----------------------------------- <br /> Type of filter material ..-. ----------------_.Depth of filter material-----------------------Total length-...-...._-_--------------------------- <br /> c <br /> Seepage Pit: Distance to nearest well..!-�17�.1..Distance f omfp u�n/�dat�ion- O.-.......Distance p nearest lot line..�A-�. (� <br /> Number of pits----- 2---------Lining material. �j�r'. .. pr? ia r --- p -- G) <br /> Cesspool: Distance from nearest well.................Distance from foundation--- . -------------Lining material-------------------------------------- <br /> 0 Size: Diameter..............-----------------------Depth............................... --------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well-------------------------------------------.....Distance from nearest building------------ .............................. O <br /> ❑ Distance to nearest lot line-----------.....-- -----------------------"---------------------------------------------_-------------------------------------------- <br /> Remodeling and/or repairing (describe):-------- ----------------------------------------............................................. .........................'---------------- - V <br /> ------......••.................-----... -"------- ..................-- '-'...-......-'----'---'------.............................---------------------------------------.........----- <br /> ------------".............'-- <br /> I hereby certify I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, Stat w'-aanndArules and regulations of the San Joaquin Local Health District. <br /> (Signe ) : ( er and/orrContraetor) <br /> ------ n <br /> BY° ... (Title)------- .... <br /> ----- ----- <br /> (Plot plan, s owing size o 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 /> - c . .._..................... - <br /> REVIEWED BY'--- ' ........ "----------------' - - -' ------------- - DATE ...... . - --' --- <br /> BUILDING PERMIT ISSUED---'--"-' ' - - --------------- --' -' '--- DATE...------'------.. <br /> Alterafions and/or recommendations - - - -- ----------------------------"------"------- --'-'-' ......- -- -- <br /> ' ���--------------------- <br /> ..........-........................ ....."'-'---..-- ------. -------------------------------------------------- <br /> - <br /> FINAL INSPECTION BY:....0 -�........__. ------------ ---------- Date ---/ �."..u..� ---'--- -......... <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 />