Laserfiche WebLink
P ✓ <br />APPLICATION FOR SANITATION PERMIT Permit No. ___1 -------_----- <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 the work herein described. <br />This application is made in compliance wiifh�CJounntry Ordinance <br />No. 549. <br />JOB ADDRESS AND LO TION g�1 _0 l - ------------------------------------------------------------------------- <br />Owner's Name ------------- roC_"------- Phone-_ -------------------------------- <br />p�a � <br />Address---- ---------------------- -4- lv- ---- r <br />� -- -- - --- ------ <br />Contractor's Name----------C-,�i=-- --- . ------------------------------------------------------------------------------------------------ Phone ----------------------------------- <br />Installation will serve: Residence ❑ Apartment House ❑ Commercial Tr -Trailer Court ❑ Motel ❑ Other ❑ <br />i <br />Number of living units:"___ Number of bedrooms `__ Number of baths __!__- Lot size.f�-------------------------- <br />Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table rx ft - <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 E' New Construction: Yes Rl"no ❑ FHA/VA: Yes ❑ No [+9— <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 welllql_ Distance from foundation --- /�__.__.Mat�al____Lt _ __ _ ___2 _______ <br />�^ No. of compartments____-_rte______________Size- _1�___r_---- Liquid depth $_05'-4 Ca aci <br />el <br />Disposal Field: Distance from nearest welt�l��_ Distance from foundation___%46_______.__Distance to nearest to Ii e___.$ ____. <br />Number of lines________________ _ ____ /Length of each line___---- ! Width of trench________ <br />G+ <br />-� - -- <br />Type of filter material- _A_4W Depth of filter material____, �G�______Total length --- .._._._------------------------- <br />Seepage <br />____.__________________ <br />p g Distance from f dation___ . <br />See a 4� Pit: Dis#ante to nearest well__i____.__.D- t rte to nearest lot line____ _. <br />[� Number of pits ______,----------- Lining material_.�.�___-_Size: Diameter_.��Depth___ s—_�__________._ <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- ___ -4 <br />---- ----------------------- ----------------------- <br />Remodeling an repairing (describe}:_____ __-_ <br />------------------------------------------ ------------------------------•----•--------------------------------------------------------------------------- <br />----------­-­-- -------------•-------•--•-•-------------------------•--- <br />40 <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, d rules and regu tions of the San Joaquin Local Health District. <br />r ------------- <br />(Signed) {r Contractor) <br />By:-----------------------------------pafion <br />-------------------------------------------------(Title)---- ------------' _----------- <br />(Plot plan, showing size of lot,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 />REVIEWED BY---------------------------------------------------------------------------------------lY\------------------- DATE + it <br />BUILDING PERMIT ISSUED----------------------------------------------------------------------- DATE---------------- <br />Alterations and/or recommendations--------------------------------------------------------------------=-----------•------------------------------------ ------------------------------------------ <br />-----------------••-------•----•---------------------------------------------------------------------------------------------------------------------------------•---•------------------------------------------------------- <br />------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------ <br />-------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------- <br />------------- ------------------------------------------------ <br />;;� --------------------------------------------------------------------------------------------------------- - ----------- I ---------------------------- <br />FINAL INSPECTION BY-------- ---- ---- -•- -- -- ----------------- Date---/,�/ <br />--------- - <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />130 South American Street 300 Wes}'Oak Street 132 Sycamore Street 814 North "C" Street <br />Stockton. California Lodi, California Manteca, California Tracy, California <br />ES -9-2M . Roviseal 1-57 F.P.CO. <br />U <br />t <br />i <br />4 <br />0 <br />