Laserfiche WebLink
FOR OFFICE USE: <br /> -�_��_l�-_��_- ---.. -.--�_ � -�_- APPLICATION FOR SANITATION PERMIT Permit,No.67 ; ............ <br /> A <br /> -------------- r --- (Complete in Duplicate) I <br /> .. <br /> - This Permit Expires 1 Year From Date Issued 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 tri'6861n compliance with County-O-Minance No. -549,: <br /> JOB ADDRESS AND -LOCATION = `� l x._r.0.A_e--------fl!-�---------- <br /> - --------------- <br /> Address-----•------------��- --�. ��-�r_� -��---��� --------•-- ----- ---- �- -- �------- "------•--------------P_hone__5f�_Z_y'...`�_��_�. <br /> Owner's�Name_:__- <br /> 1 K <br /> I 1 � <br /> IContractor's Name---------- 'F< ��-------`�-z�----t&----------------------------- ---------------- ------------------------------ Phone--------- -..----------••--------- <br /> 1-It fallation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court [Motel ❑� Other ❑ <br /> Number of living units: _-Y.--- Number of bedrooms -------- Number of baths -------- Lot size _____.3__._#5�q-' t...........:...._--..--.--_--.--_ <br /> Water Supply: Public system ®" Community system ❑ Private ❑ Depth to Water Table -4.47�ft. �:^ -- <br /> i Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [!Hardpan ❑ <br /> Previous Application Made: �(.If yes;date--------..---------) _No.❑-..:New. Con str-ucf.ion.:„ Yes ❑ No R3- FHA/VA: Yes'[-] No ❑� <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: IF <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> ' J <br /> Septic nk: Distance from nearest well-----------------Distance from foundation-----------------. Material ..-._.-._..--_-_...----..--_-_-.-.____---_--.-_. <br /> No. of compartments-- ---------- - -- -------Size----------------.---------------Liquid depth------------- -----------Capacity-- <br /> - - --------------------- <br /> Disposal 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 /> aSeepage Pit: Distance to nearest well.../1_-k_h-'-___.Distance from foundation---_yl_pj.-._._.Distance to nearest lot line--�___._ <br /> 4 [ Number of pits------- -------------Lining material-----Ra­__l``--Size: Diameter._..'V1_."_.----- Dept h------�-5.................. N <br /> Cesspool: Distance from nearest well-----------------Distance from foundation.........-----------Lining material-------------------------------------- <br /> f Size: Diameter--------------- ----.-.-__---.De Depth------ --------Li Liquid Capacity-.-. <br /> .,,❑ ------- - P -------------- - q --------------=---------gals. <br /> Privy: Distance from nearest well ---------------___-----_._---_-._--_-._.......Distance from nearest building--------------------- <br /> _------_--_-_-_------. <br /> 1 j`❑ _____-.—_...Distance to nearest lot Eire_-------------------------------------------------------------------- ------------------------------------------------------- <br /> �_ <br /> Remodeling and/or repairing (describe):-------------- --------------`---------_r----------------------------------------------•--------------------------------------- ------------- <br /> " --__•_--^----------'----------------------------------•----------------------------------------------------------------•------------------------------------------- -------------------------------- <br /> --------------- <br /> 6. <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, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> -- <br /> (Signed)------------------ _. -_ r------ --------(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 /> i <br /> FOR DEPARTMENT USE ONLY <br /> I <br /> ' APPLICATION ACCEPTED BY----- - ---------------- DATE----- ----- ----- <br /> --------------- <br /> REVIEWEDBY------------------------------------ --------------------------------------------- DATE--------- --/ <br /> BUILDING PERMIT ISSUED--------------------------------- DATE_-- _ <br /> Alterations and/or recommendations:-.1�1 =_:- ...__=�=�---------- -~- <br /> d ! f i <br /> --------------------------------------------------�-- --------------------- <br /> ---------- ---------------------------------------------------------------------------------------------------------------------- `--------------- -------------------------------------------------�' <br /> r , <br /> -------------------------------------------------------------------- •--- `------------------- --------- ------•-------------- ------------------------------------------------------------------------- ------- -------- <br /> FINAL INSPECTION BY:. / -�" Date---------zT ez— --------------------- ----------------- <br /> i SAN JOAQUIN LOCAL HEALTH DISTRICT . <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> Ct <br />