Laserfiche WebLink
FOR OFFICE USE: <br /> --------------------------------------------------------- <br /> --------------------------------------------------------- <br /> APPLICATION FOR SANITATION- PERMIT Permit No. .r;Z/ .- <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 instal[the work herein described. <br /> This application is made it compliance with County Ordinance No. 549. <br /> ��pp <br /> JOB ADDRESS AND LOCATION./---�-A _, :.. ? _14 --------n - - -_4------------------------------------------ <br /> Owner's' Name---A _ _-- _ - - Phone----------------------------- <br /> ---_h-'�� ` -------��tizr� <br /> --- <br /> Address -------------------------------------------------------------------------------------•---------------------------------... <br /> Contractor's --------------------•-------•--•--------•-••-- -----------•----- Phone--------..--.-..--•-----•--•------- <br /> Installation will serve: Residence W Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ti <br /> Number of living units: /----- Number of bedrooms -3---- Number of baths _ '-- Lot size ---------------------------------- <br /> Water Supply: Public system ❑ Community system ❑ Private J�} Depth to Water Table 20- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam DO Clay LoamA Clay ❑ Adobe ❑ Hardpan <br /> Previous Application Made: (If yes,date :._.....-'_._. _._-] No ElNew Construction: Yes [I No ❑ FHA/VA: Yes E] No 0 <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 well----- ---------Distance from foundation -------- Material-------------...__-___._____-__._-._.___ <br /> No. of compartments-------------------------Size------------------------- ------Liquid depth------- ------------------Capacity-------------- ------- <br /> Disposal Field: Distance from nearest w 1l,CP_t Distance from foundation----L_P_"t7__:Distance to nearest lot line--_1__---. <br /> Number of lines------t��___` - ----------------Length of each line...--.10TP-------------.Width of trench._AY_*1-----..-_._.--._--- <br /> Type of filter material��_��_-_.......�Depth of filter material-__/_'.............Total length_- X40------------------------- <br /> Seepage Pit: Distance to nearest well.-_-_-.kr_r�-------Distance from foundation-_---__-_____---.Distance to nearest lot line----------------- <br /> ❑ Number of pits----------------------Lining material--------------" _..Size: Diameter_----------------------Depth-.----.------------------------- <br /> - <br /> Cesspool: Distance from nearest well-----__-��__Distance from foundation--------------------Lining material-------------------------------------. (� <br /> Size: Diameter------------- ------------------- ----De th------I-------- ?-- -----------------------------Liquid Capacity.. alS. d <br /> Privy: Distance from nearest well----- ---------- -----------------I--------------- from nearest building-----_---_-------------------------------- <br /> El Distance to nearest lot line-------------------------- --- - ---------- ------------------------------------------------------------------- ---------- ----------- <br /> Remodeling and/or repairing (describel.___444 - ------------------------------------------------- <br /> �- <br /> F <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)-------------------------------------------- ---- .-------__,________---- _ Owner and/or Contractor <br /> y.------ _ E -------------------------------------------(Tifle)---------- <br /> (Plot plan, showing size of lot, location of syste Irrt n relafion to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED --- -- ---------------------------------------- DATE-2-7 _3_7.e.07--------------------------- - <br /> REVIEWEDBY------------------------------- -- - ----------- ------------------------------------------------------- ------------ ----- DATE_-------------------------------------------------------- <br /> BUILDINGPERMIT ISSUED----------------------------------------- ------------------------------------------------------- -- DATE------------------------------------------------------------ <br /> Alterationsand/or recommendations--- --------- ------------------------ ------------- ---------------------------•-----------------------------------------------•----------.-- --•--- -------- <br /> -------------------------------------- ----------------------•------------------------------- ------- ----------------------------------------------------------------------------------------------------------------------- <br /> -----•---------- ----------------------------•--------------------------- ---------------- ------ ------------------------ --------------------------- ---------------------------------------------------------------- <br /> --------------------------------•--­­------ -------------------------- --------------- ... --------------•-------------------------- ---- ----------------------------------------------------------------------- <br /> FINAL INSPECTION BY:........ ----------- ---------. <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 /> F.P.co. <br />