Laserfiche WebLink
FOR OFFICE SE: , <br /> ------------� - -- - / Permit No. - --' -.d--•---.��_. <br /> r-- - ___� �___�- -� APPLICATION FOR SANITATION PERMIT 9 <br /> ------------------------------ (Complete in Duplicate) <br /> Date Issued ----- <br /> _ This Permit Expires 1 Year From 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. 5 9 <br /> JOB ADDRESS AND OCATI --- /76?_.�?_.:� -(`/ ] =-----------------------------------------------------------------------------•------------ <br /> Owner's Name--/- ---�-/ --------14w,-r----- -------------•------------ -------`------ -------------------- ---------•--------._..- Phone-----.._.--•------------- --------- <br /> Address ----------------------------•----------------------------•--------------------- ------------------------•---•------- <br /> Contractor's Name---- --------- a -­Of0 Phone <br /> Installation will serve: Residence d-i partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ___ __ Number of bedrooms 9--- Number of baths /.... Lot size ------------------------- <br /> Wafer Supply: Public system ❑ Community system P�Private ❑ Depth to Water Table 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 g?'No ❑ FHA/VA: Yes [!J-'No ❑ k� <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: L` <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.)) Q <br /> Septic Tank: Distance from nearest we ___' ____Dis#an��+e f�m foun ,tion___ t!-_______-Mata Material - _ L�- •-- ---------- <br /> IV <br /> --------. <br /> ��� No. of compartments---- ---------------Size_AAK---X-%�----.Liquid dep�h----_�__.A-------------Capacity__460p_'--- <br /> Disposal Field: Distance from nearest well----- __._Distance from foundation....`p___._..-Distance to nearest lot line__, <br /> Number of lines_____________+ _.. _ ____.-- Length of each line_.7� 1_._.________.Width of french.vt . <br /> Type of filter material__��G%�Depth of filter material_._ � ll___Total length _� <br /> g p - <br /> Seepage Pit: Distance to nearest well--------- ---------Distance fr m fou dation__,�.�__.D' t ice to nearest lot liae __�_-_ N <br /> Number of pits.----/-----------__Lining material__�,1G�Size: Diameter_ ___...___Depth_ +a�____ A, �� <br /> Cesspool: Distance from 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):--------- ----------- - - - ------ -- --• ----•--- --•-------------•----•---------------------------------------- <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 rules and regulations of the San Joaquin Local Health District. <br /> {Signed) - --- ---------------------------------- •------------(Qw,ner- Contractor) <br /> Title /`--- <br /> (Plot plan, showing size of lot, location of system relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----- `____ _ z8r� <br /> - -- -- ----- - ---- -------------- -• ••- ------------------ DATE-----2 -• ------------------------------------------- <br /> REVIEWED <br /> ----------------------- - <br /> REVIEWEDBY----------------------------------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------ <br /> BUILDINGPERMIT ISSUED-------------------------------------------------------------._---••--------------------------------- DATE---------------------------------------- ------------ <br /> Alterationsand/or recommendations----------- ----------------------------------- -----------------------•--•-------------------------•-------------------------------•-----------•----••-.----- <br /> ------------------------------------------ <br /> -----------------•---------------------------------------- ----- ---- ---- r ----------- <br /> ----------------------------------I------------- <br /> FINAL INSPECTION BY:--- ._ .,. Z� 2 Date.............�' 2 _.._ <br /> ' --------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 330 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California . Lodi,California Manteca,California Tracy,California <br /> ES-9 REVI6EC a-59 F.F.00.2M 6.60 <br />