Laserfiche WebLink
7 <br /> P,-r`LICATION FOR <br /> -� SANITATION PERMIT Permit No. __..�.!_3._�...-_. <br /> L (Complete in Duplicate) Date Issued <br /> l <br /> Application 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 rade in corn ante with County Ordinance No. 549. <br /> GSI / t <br /> JOB ADDRESS AND LOCATION--- - "_ - <br /> - ff. <br /> Owner's Name------ �= = ------- Y.1.._---- Phone----- <br /> Address � ._ . ........... <br /> ---------------------------------------------------------•- <br /> - - -- <br /> Contractor's Name - tC/t'� -{t, �'= �_t? `------------------ Ph one <br /> - =c - - <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ' <br /> g �' = = <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 /__7 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 ❑ No V/ New Construction: YesO No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> -Septic ank: js ante from nearest we _ _!l---L-DisfanCe <br /> �-,/ `•from_ -fo nda Ion__- ------- na <br /> tera <br /> No. of compartments....c ___..--..Size._=r_�..l _r--1 _._.___Li Liquid de th___L __—- __`___-__Ca__._a._c_it <br /> Disposal <br /> Field: Distance from nearest ell_1.�--__.._Distance from foundation__ .__.......Distance to nearest lot line........!'�e <br /> Number of lines_________ _______ Length of each line.._._ _?_`________.__._.Width of trench-__--_.-...__..___--_._-._______- <br /> Type of filter mat ------Depth of filter material_-_,1.e- �____-_Total length_______ '____._-_____.--__---_---_-._ <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line---------........ <br /> ❑ Number of pits______________________Lining material-----------------------Size: Diameter_--------------------Depth____-..___--___---____-•-______-_ <br /> Cesspool: Distance from nearest well--______________Distance from foundation------------------_Lining material______.-__-_--._--________-_-____ <br /> ❑ Size: Diameter_-- --- ------- -- ------------_Depth- -----------------------------------------------.Liquid Capacity-- -------------------------gals. <br /> Privy: Distance from nearest well-._____._---__----__- ----------------------Distance from nearest building---_________---------__•____-___--_-_._. <br /> ❑ Distance to nearest lot line--- ----------------------------------------------- ---------------------------------------•-------------------•-•--•----------------- <br /> Remodeling and/or repairing (describe): 1'==�.---._.` z� ------------- <br /> ----------------------•---------•-----•-----------------------------•----•---•-----• -----•------ ---- ---•-••-------•---------•---•-------------------....-••---.------------..... --------------- <br /> . -----...<"c------•--•-------•------•--•----•--------•-------•-----•-•---•--••--••-------------••-•----•-------- <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)................ :--:____-.•= - -__-•-. (Owner and/or Contractor) <br /> ----- <br /> By:--------------------------------- <br /> (Plot <br /> ---- ----------- ------(Plot plan, showing size of lot, location of system 41 relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY------ ------------------------ ------------------- - ------------------------------------ DATE--- ------------------------------ <br /> REVIEWEDBY---------- --------------------------------- ----- - --- ---- ----------------------------------------------------------- DATE- . L <br /> BUILDINGPERMIT ISSUED---------------------------- - ------------------------------•----------------------------- DAT •--------------------------------------------------------- <br /> Alterations and/or recommendations:------- •-------------------------------------•--•....---•---•----------------••--- -----••--- -•--•---•-•---------••••--•--•----•-•-------•----•---- . <br /> -------•--•---•-••-•-•--•-----•-•--•••---•----•----•---•--------------•---------••-•.......................------------------------•-------------•-•-------•-----•--------------------------------------•------•----•----•--- <br /> . ----......•----•-•-••----•--•-- ----••----------•---------------------•--•--•----------•-----•---•---•----••-------------•-------------•-------------------•----------•----------------------•-----------•---------• ------- <br /> FINAL INSPECTION BY:- �- . --- --- -- Date...--.---- - ­----------------- `C ---••---------------_--- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 914 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M , Revised W-2100 <br />