Laserfiche WebLink
APPLICATION FOR SANITATION PERMIT <br /> Permit Na. __-- -- __---•- -- -_ <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 with County Ordinance No. 549. <br /> 2f/7 <br /> JOB ADDRESS AND LOCA ONS 't ----------- -- ----••--- I� <br /> -----------------•----- <br /> Owner's Name -p�'--�_ --- Phone <br /> Ad d ress-------------------------------•- ---•-- <br /> -- <br /> :__ _ f_ 11 <br /> Contractor's Name---------------------------------------- ----•------------ Phone •---•--•---•----- - <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑i Other U�i«��a.�� <br /> Number of living units: -.__ Number of bedrooms __1_-_ Number of baths _/--- Lot size __75_,A_e�_4--------------------_----------- <br /> Water Supply: Public system ❑' Community system ❑ Private Depth to Water Table _I.2-ft. <br /> Character of soil'to a depth of 3 feet: Sand ❑_ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ A.obe ❑ Hardpan ❑ <br /> Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ NoIE[� <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 well__yJ__________Dlstance off om fou ngationl4_?'K'"""Mate ial----------_._�_________. __ <br /> (�J No. of compartments_-__--may_ _"_-----------_�Size_��°J___�_�_�_---Liquid depth______yr-_______._ _(Capacity-­- - o � <br /> JJ`` �------ --- <br /> r + a � ------ <br /> Number <br /> Disposal Field: Distance from nearest well.'5.��_r_�r�istance from foundation,/a_�Distance to ne rest lot line___',`?__ ___.__ � <br /> Number of lines___-__ � _ Length of'each line___ _____" rig Width of trench.--_ `�----------------- <br /> Type of filter material__ ___Depth of filter material----.f --_______-Total length_.__i _ ___________________________ (� <br /> Seepage Pit: Distance to•nearest well_____________________Distance from foundation--------------------Distance to nelGrest lot line____-___-_____ <br /> ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------- <br /> Cesspool: Distance from nearest weli-------------------Distance from foundation-------------------.Lining material!_--_-_--- ____-______-_______-_____. <br /> ❑ Size: Diameter---------------------------------------, Depth - --- ---------_--Distance from nearestibui dapacit�i_.-___:----------------__-_g <br /> ------------------ <br /> gals, <br /> Privy: Distance from nearest well------------------- 1_._ <br /> ❑ Distance to nearest lot lire-----------=------------------ ------------------------------------I------------ --=-'-I.'-------------------- r <br /> Remodeling and/or repairing (describel:-------------------------------------------------------------------------------- --------------------------------- - <br /> 1 <br /> ------------------------------ <br /> -------•--------------------------------------------------------------------•--------------------------------------------_------------------------------ � i <br /> ---- ------------•-------------------------------- 1-------------------------•----------- I <br /> 11. <br /> ---------------------------------------------------- •---•--•---------------------------------------------------------------------------------------- -•------------------- # i <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 an regulations of the San Joaquin Local Health District. <br /> J / - --------------- Owner,and/or Contractor <br /> (Signed 1 ��'h "dam 1. - - - --- - ----- - ------------ { I / 1 <br /> ------------- Title -------------------------- <br /> Plot Ian' showing size of-lot;''location'of s$ tem irf relation�•tow+ells build in giefc.,-can 6e. laud on reverse side ` <br /> �RDEP RTMEN�T USE O�,LY <br /> APPLICATION ACCEPTED BY---- DATE---- <br /> REVIEWED BY-------------------------------------------------- -e - ------------------------------------------------------ <br /> ..t,.� -'-------------- - ------ QATE------------------- ---�--�---------------------- j <br /> -• <br /> ---------------------•-------- <br /> BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE.--------------------- --------------------------------- <br /> - <br /> Alterationsand/or recommendations--------------------------------------------------------------_-----------------------------------------------------------il------------------------------------- <br /> --------------•--•-------------•---•-----•----------------------------------- --------------------- --------------------------------------------------•----- ._..--•---.... ---••---- •---•---..........I.---....I-.----- <br /> --------------------------------------------------------------------•------------------------------------------------------------------- ---•------- --••----•----•--•---------_...._ <br /> -------�N---•--------•------------==------•--- <br /> I� <br /> ---------•--------------------------------------------u________ _____---------------------------------------- ------------------------------------------------ ------------------ ---- ---------------------------------- <br /> FINAL INSPECTION BY________ --�L_-_� Date----=------- _ ql--S P ----1----------------- <br /> _ _ _ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT I <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 (North "C" Street <br /> i <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M , Revised 1•57 F-P.CO. ' <br />