Laserfiche WebLink
..-- _.__.. /��_ '__---.�_ . -G APPLICATION FOR SANITATION PERPermit No:":/.� <br /> - (Complete in Duplicate) <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 made in compliance with County Ordinance No. 549. ; f -USO- Z <br /> " x`'12-2_ t.cJ- C-Le F7-0,J.0-ou�T q� <br /> JOB ADDRESS AND LOCATION ��..((ff� ----- Qnco.`-rs1 --------K !4 ---------- 4:-------o -------�I------------------------------- <br /> Owner's <br /> ---------�'� <br /> Owner's Name uj-1--L.l- _A_ <br /> Address------------------------------------------- <br /> X k1 <br /> --------- ?. 9-.----- Y --------------5--H---------------------------------------- <br /> Contractor's Name12 6L1 r _2PQ---------------------------------------------- Phone- �Q•.1_ .Q <br /> Installation will serve: Residence [X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> f; <br /> Number of living units: ..----- Number of bedrooms _-1-Number of baths ---I---- Lot size ----- ---- -.:..._._---.. -------------------- <br /> Water Supply: Public system ❑ Community system ❑ Private 4 Depth to Water Table Q__ ft. ' <br /> 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 Construction: Yes ❑ No A FHA/VA: Yes-S_/ NoFf <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 we1i._-'1-".-.-.Distance from foundation.._.. Material -__�--------- ---- ------ <br /> No. of compartments �„ + Size 6xr7 q 'p r - ---------Capacity u r <br /> p ---:---Liquid id de th-- <br /> Disposal Field: Distance from nearest weli_r-160 If Distance from foundation-----13...........Distance to nearest lot line---—.... <br /> ... <br /> /r��� Number of lines..............3.. - -Length of each line-"�D-------- <br /> 1��_ Width of trench-....-_�.�crr-- <br /> Type of filter material K Depth of filter material-------- --- ----- -Total length-------------- 0 <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line..--_------------ <br /> ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------..----Depth--------------------------------- d <br /> Cesspool: Distance from -nearest well-----------------Distance from foundation_-----------------Lining material.-._-------------------------------- <br /> ❑ Size: Diameter-------------------------- -----------De th------------- ------------------------------------ <br /> P --Liquid Capacity------------------ --------gals. ' <br /> Privy: Distance from nearest well...................__------------ -----------..Distance from nearest building----------------------------------------- 0 <br /> ❑ Distance to nearest lot line-- -------------------------------------------------------------------- <br /> ------------------ <br /> Remodeling and/or repairing (describe):--- _IVlO ----------------------------•----------- -------- <br /> -----------------­ --------------------------------------- <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 rule and regulations of the San Joaquin Local Health District. <br /> (Signed) ---------4Qrk-R.1S 1 J -C� (O er and/or Contractor) ; <br /> B'Y*-------------------------•------------------- (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---- --- -3- -5 ------ <br /> REVIEWED BY-------------------------------- <br /> -.1 ------------------------------------------ --------------------------------------------- DATE-------- --------------------------------------------------- <br /> BUILDINGPERMIT ISSUED--------------------------------------- -------------------------------------------------------------- DATE-- ---------------------------------------------------------- <br /> Alterations and/or recommendations------- ------- ----------------------------- <br /> ---•--------------------------•--------•---•----- ------------------------------------------- ------------------------------------- ------------------------------------------ ----------------------- <br /> ---------------- -•------------- --------------------•----------- --------------------------- - -- ------------------------------------------ -------------------------------- - --- -------------------- -------------- <br /> FINAL INSPECTION BY:.._ --------- Date-.-- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT­- <br /> 1601 <br /> ISTRICT -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 /> F.P.C Q. <br />