Laserfiche WebLink
APPLICATION FOR SANITATION PERMIT Permit No. ------------------------ <br /> (Complete <br /> ...------- S(Complete in Duplicate) <br /> WADate Issued__________________ <br /> Applica+ion is hereby made to the Saln'Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> 3 <br /> .SOB ADDRESS AND�LOCATION---- -- - ------------- G_a ��? � V� T Qc.�cfQ�''Z------------------------------ <br /> Owners Name-------------- .as 1 Q_Q- °, - = Phone7T2�-- Q - E <br /> Address --------------------------------- <br /> ---- <br /> -3L--- -Tf.- �-u��i`------------- ------------------------------------------------ ---------------- <br /> Contractor's Name------------------ - -• <br /> --- ---• •---flat`LJS� /? ---------------- Phone �'•t�'���� <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial 9 Trailer Court (] Motel ❑ Other ❑ <br /> Number of living units: ..../_ Number of bedrooms __:C"_ Number of baths ____1-'Lot size .- .T___-2!!t�-------/_ O____________________ <br /> Wates• Supply: Pubiic,system Community system ❑ 'Private ❑ Depth to Water Tablec;46?ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑' Sandy Loam ❑—Clay Loam❑ 'Clay E]'--Adobe Hardpan ❑ <br /> Previous Application Made: Yes ❑ No New Construction: Yes E] No E] <br /> TYP 1= INSTALLATION AND SPECIFICATIONS: ISI <br /> [No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> 5eptic,Ta k:r Distance from nearest well_________________Distance from foundation______-__ .,__._.Materia _______i___.___-_.-____._ <br /> ---------------------- <br /> .No, of compartments--------------- - th <br /> -----Size--------------------------------Liquid de ----_---------- ----Capacity <br /> posal ie! Distance from nearest wefi------------ Distance from foundation__________ ________Distance to nearest lot line----------------- <br /> Nu-tuber of lines----- ---------------_----------Length of each line--------------------- -=------Width of trench----------------------------------- <br /> Type of filter material.__._____1- ----------Depth of filter material________ s-. -Total length_____________________________________ <br /> 1. <br /> Seepage Pit: 'Distance to nearest"well_-1QN�_______Distance fr f undafion__ ,_:__._-.D]istance to nearest lot line--S________ <br /> XNumber of pits-----1�____-_______Lining material Z"3 _ Size: Diameter__-__ Dapth---.I--a ----------------- <br /> 0 <br /> Cesspool: D'stance from xnearest well_________________Distance from foundation____,_'__.;___._._.Lining ma aria)___.--__._____..__-__- ..�I <br /> El Size: Diameter-------— --------`-------------------De th-------------------------------------- ----;_____Liquid Capacity --gals. <br /> Privy: Distance from nearest <br /> rwell----___---------------------------_--------------Distance from nearest building_____________________________.____-___ <br /> . i LF­] -Distance to nearest:lot•line----------------------- -- r -----------------:-_-. <br /> ,r <br /> Remodeling and/or repairing (describe}--------------------------------------------------------------------------•----------------- - ------------------------------------- <br /> ------------- <br /> ------------------------------------ <br /> ----------------- -------•-----:----------------------11-----------------.-•.- -------•----------------------------------------------=------- ----••-------------------------------•-------- <br /> t � . <br /> ii <br /> ----------------------------------------- -------------- •--------------------------------------------------------.-------------- --------------------------------------- <br /> 1'herebser#+#y.t at I have prep ed this application and that the work wi I be done in accordance with San}Joaquin County <br /> ordinances, State laws, a jrulle and r ulations of the San Joaquin Local He Ith District. <br /> +' <br /> (Signed)------------- -- - - ----------------------------- ------ -- ----- -- -- ----------------------------- , Contractor) i <br /> By:--------------------------.......------------f�--------------------------------- (Title) ��C�I'l±f� C�-��-------- ------------- <br /> (Plot plan, showing size of lot, location of system in relati(n o wells, building tc., can be placed on'reverse side). 6 <br /> S t f <br /> * z FOR DEPARTMENT USE ONLY ' <br /> APPLICATION ACCEPTED BY-------- ? ---------------------- ----------- - - ------------------------ DATE ------------------------- <br /> REVIEWEDBY-------------------------------- ---- -- ---------------------------------- ---------------------------------- DATE--------------------= ------ - . <br /> BUILDINGPERMIT ISSUED---------------I----------------------- -------------------------------------------------------------- DATE------ --------------------------------------------._..._...- <br /> Alterationsand/or recommendations.------------------------------------------------------------------------------------------------------------------------ -------------------•-------•-_--------- <br /> L I <br /> -----------------------------------------------------•--------------------- -------------------------------------------------------------•-------•--------------------------------------------------------------------------- <br /> i <br /> ---------------------------------------------- --------- -------- -------------- ------------ ------------ - - ----------------------------- --------- ---------------------------------------- <br /> --- - - ---- --------- <br /> FINALINSPECTION BY---------------'----------------------------------------------- Date-------------------------------------------------------------------------------- <br /> 1 <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 Revised W-21001 <br />