Laserfiche WebLink
`APPLICATI®N FQR SANITATION PERMIT -Permit'No: . <br /> (Complete in Duplicate) Date Issued - .3!!V <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 ith County�Orcli <br /> � toanceNo.�5"49 <br /> JOB ADDRESS ,-_-------- _,_ ---------- ---- <br /> --- '... <br /> -- ^; <br /> .... Phone__.----------------------------- <br /> Owner's <br /> ---- ----�----- <br /> Owner's Name „/. -------------- ------- ----------- <br /> __711 --- --------- --------------------------------------------------------------------------------------------------•--------------------------- <br /> Address <br /> Contractor's Name_--- -- - -- Phone----------------------------------- <br /> ---- <br /> ------- ---- ----------•---------------------- <br /> Installation will serve: Residen ®' Apartment House ❑ Commercial [] Trailer Court Motel ❑ Other <br /> i <br /> Number of living units: -0_ um er of bedrooms -------- Number of baths -------- Lot size ___ ___._____.________________ ______________----- <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water--Table -------- ft. <br /> Character of soil to a depth of 3 feet- Sand E] Gravel F] Sandy LoClay Loam ❑ Clay E] Adobe Hardpan [:1F Previous Application Made: Yes �o ❑ New Construction: Yes ;PNO <br /> ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Sept'c..Tank: Distance from nearest well________________Distance from foundation--------------------Material_-____.__,_____.__-_---____________..___.__-__-. <br /> No. of compartments----- ----------------- Size--------------------------------Liquid depth------------------------' Capacity----------------------- <br /> Dispopl- 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 /> Spepaage.Pit: Distance to nearest well-._____,______________Distance from foundation------------.____-.Distance to nearest lot ine_.._____-__-__-__ n <br /> ® Number of pits----------------------Lining material-.---------------------Size: Diameter--------- ------Depth-------------------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation------------------_Lining material-_-_______________-_.___....__.__-__. <br /> Sizo: Diameter------- ------------------------------Depth--------------------•• ------ ----------------------Liquid Capacity----------------------------gals. <br /> Priv Distance from nearest well-------------------------------------------------Distance from nearest building---------- ---------------_____-_.------ <br /> ❑ Distance to nearest lot line------------ --------------••---------- --------------------------------------------------- <br /> n, <br /> ---- --------------n,deli g and/or epairing (des.be)-------- ----- �---- ------ ---- --- ------•------------------- <br /> f� <br /> -------------------------------------------------- <br /> J •S.eY <br /> , --- ------ <br /> - -- -------------------------------------------------------------- -------------------------------------------------------------- <br /> I hereby certify hat I have prepared this application and that the work will be dans in accordance with San Joaquin County <br /> ordinances, State laws, and r s and regulations of the San Joaquin Local Health District. <br /> (Sig ned)-------------�* 6- tc_ ---------------- ---------------- --------------- --------------- <br /> ______._____.(Owner and/or Contractor) <br /> - - --- -------------------------------------------------------------------------------(Title <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 /> REVIEWED BY----------------------------- DATE <br /> BUILDINGPERMIT ISSUED----------- ------------------------ --------------•--------------------------------------- DATE __- ---------------------- ---------------------- <br /> Alterations and/or recommendations.----------------------------------------------- ------•----------------•------------------ = <br /> i ----••--------------------------- -----------------------------•--------------------- <br /> ------------•--------•---- -------------------------------------------------- <br /> 1 ---- -----------------------------------------------------------..---------------­------ <br /> ------------------------------ <br /> ----- ---------•-- ----------------------------------------- <br /> 11 <br /> ----------•-----------------------------------------------------------•-- ------------------------•------- <br /> -) <br /> k Z Date. L--- --------- <br /> FINAL INSPECTION BY:_._.__ --! ---- ---'-%--- ,=� ` <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 r Tracy, California <br /> ES-4-21v1 10-52 Revised W-2800 <br />