Laserfiche WebLink
C > APPLICATION FOR'SANITATION PERMIT Permit No. .-L��__�--- <br /> Corr► lete in Duplicate) �' "` '3 <br /> �.� � (Complete p I Date Issued ---.---I?.1----•- <br /> Applica*ion is hereby imade 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 W <br /> JOB ADDRESS'AND LOCATION------ --- p �- -------------- _ <br /> f _ ne_ <br /> Owners Name---------- '= ------- ---- - w -- <br /> Pho <br /> —.�- <br /> --•-------_-- --�' -- <br /> Address _ _1 ' <br /> -- ----- -- = ��(/�f `�/ <br /> r/_ � _ 'e a'�rJ--------- Phone.. -• --- <br /> ------Contractor s Name__.. � <br /> _ _ -- I <br /> • .4 4 House E] Commercial E] Trailer=Court ❑ Motel El Other Ll <br /> Installation will serve: Residence Apartment <br /> 1 Number of living units:, -�-R-- N tuber�of bedrooms _ . Number of baths =r____ Lotisize ___'_____ -------- <br /> Water Supply: Public:system Community system ❑ Private'❑ Depth to­Water Table ��ft. _ ' <br /> t <br /> Character of soil to a depth oil fee+: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay-Loam ❑ . Clay ❑ Adobe �pan ❑ <br /> Previous Application Made: Yes ❑¢ No New Construction: Yes'� — ❑ ^ R <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: i E <br /> ermitFed if public sewer is available within 200 feet.) ' <br /> (Na septic tank or cesspool p P � l _ <br /> Septic Tank p Distance from nearest welL_.--------------Dcstance from foundation Material--------y_ <br /> 1z '� r ` - l ------------- Ca acit . <br /> - 1 No: of compartments t.__- _ _-- S e___-•_-: #•A --Liquid depth ___--,* t p y-•------- <br /> s + L ! ..- W <br /> , R C I <br /> Dis osal Field: Distance from nearest well- ... ___Distance from'foundation _,a _ _._ .Distance to nearest lot line____ ___________ <br /> S' p .. r Le# th of each line-'_.F - ; `�. <br /> Number oY lines_ -- ;-- gWid#h`of trench----- - --------- <br /> " '� _ _ ewe <br /> Depth of filter material__ _ r <br /> Type 'or.filter material-- " <br /> ' 4eepa e Pit: "Distance-to neares .well _ �:. __Distance-f&o Ti-%ur6da iior to nearest <br /> ize: Depth . <br /> 1 p g � Diameter- ----- - - ----- <br /> r <br /> Number of its.__ <br /> -Cess ool: Distance from nearest-well_______-____Distance from foundation___________ __;--- 'Lining material-----------------__________ <br /> Linin material_ _ <br /> p F, ' - " Li uid Ca acit _._._ - --=--gals. <br /> ❑ Size:_Diameter_ --------- --- De,r�}h - - q Capacity <br /> + ' _Distance from .nearest'buildin <br /> fes. Privy: Distance,fr�om nearest well. ,.-- __--4 --- T ------------------------ <br /> �- --- -- -- <br /> Distance;to nearest lot line- "` - - <br /> C�f <br /> : . . . # <br /> Remodeling and/or repairing (describe):__- - ---- -- <br /> a - ^-------± -------4-*`- ------------ - -- t --•------------- <br /> i ------------------- F !r*�— <br /> # i ,�,:r <br /> -------------------------- --- -----.------------------------------------------- <br /> ---------- <br /> ----•--------- <br /> -•-------------------------------- <br /> ___ _ <br /> --- ----- - <br /> ! hereby certify that I have prepared this applica+i n and'.that the work will -be done intaccordance with San Joaquin aunty <br /> 1 ordinances, State laws,�and rules and regulations of the San Joaquin Local Health District.,. f <br /> f <br /> O d <br /> ,p e d Own@r nd Or Contractor) <br /> - ' J r <br /> (Signed)•---- � . <br /> BY= <br /> . �`— - --------------------- <br /> ------------ {TitleJ:' <br /> --- ----- - ------- - -------- <br /> (Plot plan, showing size.of lot, location of system in relafion to wells, buildings, etc., be placed.on-reverse side). I <br /> # _ FOR DEPARTMENT USE.ONLY, <br /> l <br /> APPLICATION ACCEPTED BY ---------- --------- ' DATE = <br /> REVIEWED BY '_.., DE '------------------------------------------------------- <br /> AT <br /> := - - ---- <br /> BUILDING PERMIT ISSUED--- -_----1-- ---- -- . ------ DATE. - <br /> ---------------- ---- ---- --------- <br /> _..�.. . <br /> Alterations and/or recommendations:__.----- ........._--------------------------------•--.------- <br /> ---- - <br /> -------- ---- --------------------------------------- ------------- <br /> E - <br /> ------------- ------------- <br /> --------------------------------- <br /> i <br /> ---•----------------------------- -------- ---------•------ <br /> ----- ----- - -- ----- --------------- - -- <br /> 4L- r <br /> D .---------•-•------�---------' <br /> FINAL INSPECTION'BY:.__-__. <br /> ' ate_.- ------ -" <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South-American Street 300 West Oak Street 132 Sycamore Street 8 i4 North "C" Street <br /> Stockton, California Lodi, California Manteca. California Tracy, California <br /> ES-9—•2M Revised W-2100 <br />