Laserfiche WebLink
......... <br /> �` APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate} <br /> Date Issued ---- <br /> If C 1400 r <br /> Aplica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This <br /> app h C <br /> application is made in compliance with ounfy Ordinance No, 549, <br /> JOB ADDRESS AND �OCATION4 <br /> -------------------------- <br /> Owner's Name------- -- ------------------- -------- ..... --------- ----------- Phone_ --------------------------------- � <br /> Address <br /> hone------------------------------------ <br /> Address---------- ------------- ----- -------;0%i;---------- ---------------------------------7-----------------­-- <br /> ------------------------ ------------------ -- ----1-4 <br /> Contractor's Name----Aat-R, Phonw-94-------- <br /> Installation will serve: Residence I—Alal�ent House E] Commercial [-I Trailer Court [j Motel [3 Other E] <br /> Number of living units: Number of bedrooms _C?_ Number of baths.!�_Lot size - --- ------- ---- ---4 <br /> ------------- <br /> Water Supply: Pub]' system 4�01munify system [I Private F <br /> Public _1 Depth to Wafer Table _��ff. <br /> Character of soil to a depth of 3 feet: Sand Ej Gravel Ej Sandy Loam El Clay Loam [I Clay E] Adobe 6—Tra_rd�pan El <br /> Previous Application Made: Yes F] No E4�-�ew Construction: Yes 6 a <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 weh0*1%-_-_�_ _ Distanic from founclafion____tile_.____.Material_______ <br /> Ulf— <br /> No. of comll <br /> partmenis----- ------- ---Size_ ---Liquid depth----4Cp a c6i�f�yji a-G?------ <br /> Disposal Field: Distance from nearest we1l_0?1V_70ie_.Mstance from foundation----1_4--------Distance to nearest lot line_��Irlff�Z_L <br /> Number of lines-------- --- 7f <br /> -- --- --------Length of each line--------'v J -------Width of trench---2.-_y---------------------- <br /> Type of filter material. - -- <br /> ---- -- Depth of filter material-__ -----Total length_______' ________________ _ <br /> Seepage Pit: Distance to nearest well__Distance from foundation_____ Distance to nearest lot line__/t2, <br /> Number of pits....--/- ---- -------Lining mate ria I-AAl-le�K....Q ##------ <br /> ize: Diameter- Depth----1J,r--------------------- <br /> Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material-------- ------ <br /> ---------------------- <br /> El Size: Diameter---------------------------- ---------Depth------------------------------------------- --------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well-------------------------------------------------D;sta"nce from nearest,bujlcliiii�t---------------------------- <br /> ---- - <br /> El Distance.-to nearest lot line--------------------- ------------------ ------------------------------------------ ----------------------------------------- --- - <br /> -777' <br /> Remodeling and/or repairing (describe):_..__________________ - ------------------------------------------------------------------------------------------------- <br /> --- --------- <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------............ .................................................... <br /> -------------------------------------------------------------------------------------------------------------- - <br /> ----------------------------------------------------------------------------------------------------------- <br /> ---------------------- -- ---------------------- ------------------------------------------------------------------------------------------------------------------------------------------------ -------------------------- <br /> I hereby certify that I have prepared'fhis application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and es and r gulafflons oft San Joaquin Local Health District. <br /> (Si4ned)__ ----- ---- -- -- ---- ------ ------- ------------------------------------- <br /> ----------------------- ontractor) <br /> p <br /> ------ <br /> ...... .. <br /> By:----- ------------- --- --- .....%�.�-------------------------------------------(Title) <br /> (Plot plan, showing SiXG of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> — <br /> APPLICATION ACCEPTED BY ---------- -- -- -- -------------------------------------------------- DATE <br /> REVIEWED BY-- DATE --- <br /> --------------------------------------------- <br /> - <br /> - <br /> BUILDING PERMIT ISSUED--------------------------- ----- ------------------------------------------------------------------- DATE----------------- ----- <br /> - :4� ------------------------------ <br /> Alterafions and/or recommendations:------ ----- - -- -- - ------------------------------- --------- ------------------------------------------- ----------------------- <br /> -------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------- -------------------_--------- <br /> ------------------------------------------------------------ --- -------- ------- ---------- -I------------------------ -------- ------------------------------------------------------------ -------------------------- <br /> -----•------- <br /> ------------------------ <br /> ------------- ---------------------- -- ------ ------ ----—------- ---------------- --------------- ------ -----........... ---------------------------------------------------------- --------------------- <br /> ----- -------- -------------------- ------ -------------- ...................... ------------------------------------------------------:---------------------------------------------------- --_------------------ <br /> FINALINSPECTION BY:.. ---------------- ------------------------------------- Date--- ------------------------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT Al <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 914 �or+h "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> E5-9-2" 145446 A7WOCU 12-54 <br />