Laserfiche WebLink
FOR OFFICE USE:: <br /> -_ -. APPLICATION FOR SANITATION PERMIT Permit No. _12 <br /> 1 <br /> - --=----------- (Complete in Duplicate) <br /> Date Issued .l__•--_� ,�, <br /> --------------------------------------------------------- This Permit Ex ires 1 Year From Date Issued I <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 Ordinancp No. 549. <br /> a r ` <br /> JOB ADDRESS AND LOCATION..S_�. --------� -e-��' � -------- <br /> ---------------------------------'-------------------'-------- <br /> Owner's Name----- :.G�_._ -___..iC-� <br /> � �- - -- - - - ----'--•------------------•-'-'-'----'---------- ----'------------'-'-- -'--- '- - ------ <br /> - - Phone------------------------------------ <br /> Address--------- +�;�A2. .. <br /> ---------------------------------------- <br /> Contractor's Name------------ ' moi {Lec-�-------------------------------- --------------------------- Phone------------------- <br /> -------'-'- --------------- <br /> Installation will serve: Residence Ug-"Apartment House ❑ Commercial ❑ Trailer Court ❑� Motel ❑ Other ❑ <br /> Number of living units: _ _ Number of bedrooms _. Number of baths -j'_.. Lot si4f W ,J*(_f� <br /> Water Supply: Public system ❑ Community system ❑ Private Depth to Water TableAP_`eft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam p Clay Loam ❑ Clay ❑ Adobe 91-'1qardpan ❑ <br /> PP ( ' <br /> i <br /> Previous Application Made. If yes,date____________________) No �° New Construction: Yes ❑ No �- FHA/VA: Yes ❑ No [��. <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> 11 <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septi Tank- Distance from nearest well-APiP715tstance from foundation-7�_�'�___-_-_----Material----------------------------------------______. <br /> No. of compartments---------- -- - ----- --`Size--------------------------------Liquid depth---- ----- - - - ---------Capacity---------------------- t <br /> Number from nearest weil_-���---Distance from foundation_z"4..--------Distance to nearest lot line_ <br /> --- <br /> Disposal Field: Distance from <br /> lines___.____f___./_.._ ___ ength of each line____�C0_�_----_--_--Width of trench.A._�_________________________ <br /> J - .f'-- �� 6 . <br /> Type of filter materialf__ �"f-� Uepth of filter material___ _.._ -_dotal length_____j'�---------------------------- '11 <br /> Seepage Pit: Distance to nearest welL _f___Distance from fou dation__-S__��__-Distance to nearest lot line---549 <br /> ! <br /> ®� Number of pits-----/-_.---_-_-.--Lining material---A-���_ -T�� p r.�+�--------- p <br /> Size: Diameter_ _________------� De th � +��� 'V <br /> Cesspool: Distance rom nearest well-----------------Distance from foundation---.----------------Lining material_...__--.-.--------------------.----- <br /> ❑ Size: Diameter--------------------------------------Depth-------------- --------------------- ------------ -Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well -..____._------------------------_-------------Distance from nearest building----------._______.________-.____.___._. <br /> ❑ Distance to nearest lot line--------------------------------------------------------------------------------------------------------------------------------------- <br /> Remodeling and/or repairing (describe):_. a - <br /> - <br /> ---------------- <br /> i <br /> ---------------------------------'-------------- <br /> --------------------------------------------------------------- --------- <br /> ------------------------------------------------- <br /> -------------------------------------------------------------- <br /> ---------------- <br /> i` <br /> I'; <br /> I hereby certify that I hive 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 /> (Signed) d --------------------(�or Contractor] <br /> By:-------------- ---•- -' �- (Title}--- <br /> - -' •------------ • --------- -�---- L'� ---'-----------------------------'------ - -/�-'��.-..............------------- <br /> (Plot plan, showing size of lot; locatio f system in relation to wells, buildings, etc., can be placed on reverse side}. <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED SY--'---------- ZZZ ---­---------------------- ---------------------------------------- DATE------- <br /> REVIEWED BY. - ----------------------------- DATE------ <br /> PERMITISSUED---I�------------------------------------- -------------------- -------._ DATE--------------------------- ---------------------------------- <br /> Alterations <br /> ---=--------------------------- <br /> Alterations and/or recommend <br /> a <br /> tions:---- .------------ -------- � ---•----------------•---•------------------------- <br /> ------------------------------- <br /> --- <br /> -------------------------------- - - - -- ------I ----- -4-eX.-_ <br /> ------ -----------------------------------------------------------------I----------------- ------------------------------------- <br /> ------- --------- <br /> ----------------------- <br /> -•----------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------ ------ ------- <br /> -------------------------------------------- <br /> FINAL INSPECTION BY:---.'I--------- ............ <br /> .r -.-------_-----._.. Date----------------- ------------�---------;r--- F <br /> ii <br /> I� SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street <br /> Stockton,California Lodi, California Manteca,California Tracy,California <br /> p <br /> F.p.CC. <br /> �1 <br /> i <br />