Laserfiche WebLink
APPLICATION FOR SANITATION PERMIT Permit No ;. <br /> (Complete in Duplicate) a p 3 <br /> Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and instal] the work herein described. <br /> This application is made in compliance with County Ordinan e NF. 549. <br /> JOB ADDRESS AND LOCATfON =1 -CLL_ - t f' �`_ti-� = rr`r`= '` ---•--------------------------- <br /> Owner's Name------------------------------------ :_ 0--1....... ------------------------------------- Phone----�- = <br /> , <br /> Address `- • :+, - ---_ --0-_--1t <br /> ------tom: - ----•---------------------------------------------- <br /> Contractor's Name--------------------------------R, I-------Z��----------------- ------------------•--------•----------- Phone----.. <br /> Installation will serve: Residence-1W Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other <br /> Number of living units: _✓_ Number of bedrooms ✓ Number of baths .'__ ize ___ _-_--________________________ d <br /> Water Supply: Public system 2T Community system ❑ Private ❑ Depth to Water Table _40ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe E' Hardpan ❑ <br /> Previous Application Made: Yes ❑ No X New Construction: Yes ❑ No ❑AC+� •e �za,� 1 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: `N <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well_>rhamE---Distance from foundation__j_ -- --------------------. <br /> ® No. of compartments____2................. ",x_3.4 "�----- <br /> Liquid depth---47 Z_~----------Capacity <br /> �---------- <br /> 63 <br /> Disposal Field: Distance from nearest weli._RQ_14_9.._Distance from foundation---f_0_'--------.Distance to nearest lot Cine___5___`______ <br /> ® Number o{ lines--------I________ ______ __ <br /> Length of each line_____, (1.:_____________.Width of trench---,�� _'_�------------------ <br /> Type of fitter material---�_�2�-___.-_____.Depth of filter material___.IS_----------Total length----------------------- �------- <br /> Seepage Pit: Distance to nearest well_f'( N_E--_._-_Distance from foundation_-fQ_'--------Distance to nearest lot line___' I® Number of pits._.__1---------------Lining material__U_8Vc_k----Size: Diameter—_15-3 Depth___�_9_-_____________ <br /> Cesspool: Distance from nearest well___._-_____._.__Distance from foundation--------------------Lining material------------- <br /> ____.____._____.------ <br /> ❑ Size: Diameter--------------------------------------Depth-----------------------------------------•----------Liquid Capacity------------- -------------gals <br /> R Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------.-------__-----________.__...__._.. <br /> ❑ Distance fo nearest lot line---------------------------------------------- --------------------------------------------------------------------------- ....... <br /> Remodeling and/or repairing (describe):_._4a"-)---- -------------- <br /> ... <br /> Y <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, Sta} aws, and ruled regulations of the San Joaquin Local Health District. <br /> (Signed)-•---------1 O- 4A-Lo- 5------------------------------------------ ------------ ' <br /> = ',=---------- -----------------------------------------(� <br /> rs­ r Contractor) <br /> rr , <br /> By: ----- - ------------- �>7 fir. __, 'v ,�,t� Title C:rrc.t �t !-------•--------------- <br /> Y - (Title) <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildit9a, etc., can be placed on reverse side). <br /> V' V <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-- `------------------------------------------------------------------- ----------------------- DATE_ ------------------------------------------------ <br /> REVIEWED BY DATE ----------------------------••---------------------- <br /> ----------------------------------- -------------------------------------- _ <br /> BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------- ------------------------------------------------ <br /> Alterations and/or recommendations:-------------------------- -------- ------------ --------------------- ------------------------------- --------•---------.-----•----------------------- <br /> -------•------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- •--------------- <br /> ----------------------------------------------•------------------------------------------------------------- -----_---------------------------------.-------------------------------------- --------------------- ------------ <br /> FINAL INSPECTION BY:----- ----- ------=--------- -------------------- Date--------- ------------ �-- <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 10-52 Revised W-2100 <br />