Laserfiche WebLink
FOR OFFICE USE: <br /> - - --------------------------------- <br /> --------------------------------------------------------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. ___97-l9__o Sy <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 Healfh District for a permit to construct and install the work herein�described. <br /> This application is made in compliance with County Ordinance No. 549. 0' c� Z� <br /> JOB_ADDR:ESS-ANDdLCA�TION + - r <br /> Owner's Name-- �, i.. � � �..�---- -�-- - - ---------- J--------------'----------- -------- Phone. , 1 --l-1-, <br /> Address--------------•---"tel-`----------------- -p ✓ ; <br /> Contractor's Nam a- r_ __ _ __ f( t C� .__ 'Q Phone_f,-� _��- ocJ, <br /> Installation will serve: Residence ,-,r,S ^�p artm�nt House iaE]Commercl <br /> Irailer Court El Motel ❑ Other L]G ❑ <br /> Number of living units: _ --- Number of bedroom, s _-._ Number of baths/_ -Lot size __�C�� .y ----------- <br /> Water Supply: Public system ❑ Community system ❑ Private21- epth to Water Table f. <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----------.7--------) No ❑ New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if pu,§Iic sewer is available within 200 feet.) ` Mate iaL_ �-�L�-.______ .,___. .___..�ht <br /> Septic Tank: Distance from nearest weal _ ----_ __Distance from foundation__.__ff// <br /> No. of compartments_.,..____.--�-_--.--Size5i47.44 _3,r_t Liquid depth.-._ " Capacity---- <br /> Disposal Field: Distance from nearest well.4570__�__Distance from foundation------ to nearest lot line---1 -`' { <br /> Number of iiries____�______ C__._�_ Length of each line----�(1.f_._..f�______.Width of trench__ _ ___________________ <br /> Type of filter rnaterial�i�.___Depth of filter mater al___..,� Total length.__.____ ___._--_-.__-------. <br /> 'Seepa e Pit: Distance to nearest well______________ J_Distance from foundation--------------.._.-.Distance to nearest lot line--.--_____.___- <br /> . Number of pits----------------------Lining material--------- .Size: Diameter--.------.-------------Depth--.---------------------------- 1 <br /> Cesspool: Distance from nearest*well-...-------------Distance from foundation--------------------Lining material------------------- --------------- <br /> El <br /> ----- --__._❑ Size: Diameter--------------- ---------------------Depth-- ------------ ------------------------------------Liquid Capacity---------- ---------- gafs� <br /> Privy: Distance from nearest-well-------------------------- ---------------------Distance from nearest bui4&ng---.------.----------------------- <br /> Distance <br /> ---_-----_------_._ .Distance to nearest lot line.----------------- --------------------------- --- ----------------------------------------------------------------------------------------- <br /> Remodeling and/or repairing (describe:----------- --------------; - - -------------------------------- <br /> -----------------------------------------------------�' $ <br /> j y <br /> ----------------------------------- `{` � - a��L <br /> /-� � .4 --------- --- <br /> --------------------------------------: <br /> --------------------------------------------- �� .�� --- - - - -------- <br /> -------------------------------------------------------- -- <br /> I hereby certify t t I have prepared is application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws %pd rules and regulations of fhe San Joaquin Local Health District. <br /> 2a r'`��t Contractor <br /> (Signed) `� ---- ka, <br /> - �r 1 <br /> �Ef?'T'iG 'YANK �EF2V7�---------------- - - ----------- -- -- - <br /> B a5_wner_f�ve...-'-- ll�r -- {Ti#le) <br /> ................ <br /> (Plot plan, showing size of lot, location of system in relati to wells, buildi s, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY / <br /> APPLICATION ACCEPTED BY----.---- ` ---------------------- -------------------------------------------- DATE------------ >/ ° ( 66------------------- <br /> REVIEWEDBY-------------------------------- ------ - -------------------------- -------------------------------------------------. DATE------------------------------------------------------------ <br /> BUILDINGPERMIT ISSUED----------------------------------- -------------------•---------------------------------------------- DATE.----- ----------------------- ----------------------------- <br /> Alterationsand/or recommendations:---------------------- -------------------------- --•-------------------- ---------------------------•---------------------------------------------------- - <br /> ---------- ----------------------------------------------- ------------- --­­-------------------------------------------------- --- -------------------------------- --------------------------------------------------- <br /> ----------------I----- <br /> ------------------------------------------------------------------ ---------------------------------- ------------------------------- ---- ------------------------------------------------------------- ------------- ---- ---------------------------------------------- <br /> ------ - - --------- --------------- -------------------------------------------------- ------------ ---------------- ------------------ ---------------------------------------- -------------------------- <br /> FINAL INSPECTION BY:....__.. `_ 6 <br /> �� Date <br /> 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 /> g F.F.C❑. <br /> 1 <br />