Laserfiche WebLink
FOR OFFICE USE: <br /> ------------------------------------------------------ <br /> ------------------------------------------ -------------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. . 1-----i�v <br /> (Complete in Duplicate) <br /> Date issued �1-1141_"-Zl <br /> - <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. 549. 0p3 —1(0,D2b <br /> JOB ADDRESS AN L ATION-•- 's '- -----D `----------------------------------- <br /> Owner's Name/.�- '' <br /> Phone------------------------------------ <br /> Address --...... �1 f �1-7 ------- •- ------------------------------•--------------•------- <br /> Contractor's Name--------- ---------- r ""`p•---------•-------------------------------------------------------- Phone----------------------------------- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other 0 IV4— A <br /> Number of living units: ---1._ Number of bedrooms ---YNumber of baths ---1--- Lot size ------------------------------------------------------------ <br /> Water Supply: Public system ❑ Community system ❑ Private e Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan F3' <br /> Previous Application Made: (If yes,date---------------- ---I No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic;;6nk: Distance from nearest well----6-V---..--Distance from foundation—--e A-------.Material------------------------------------ <br /> e <br /> ------------------------ -------_ <br /> No. of compartments--------�y----------- ----Size--✓' -'4r- '----Liquid depth--2q---r---- -------- CaPacity----� <br /> & <br /> Dispos field: Distance from nearest well--So-'. from foundation---!t'.f---------Distance to nearest lot line-j--- ---_---- <br /> Number of lines---_------7�________________Length of each line--SP-_`_-.._____----.--.Width of trench-- -� -------------------- <br /> Type of filter material--------�- . _-Depth of filter material------1 ... --.Total length___.--/A-A---------------------- <br /> - <br /> 5eepa e Pit: Distance to nearest well----- _A6_�__-_-Distance from foundation-----�.d.-�----.Distance to nearest lot line`r.�----...- <br /> Number of pits....-----'�-------Lining material-----.-1 __ ____.Size: Diameter------ Depth-_ -5---------------------- <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 /> Distanceto nearest lot line- - ------------------- -------------- --- -----------------------•--------------------------------------------------------------------- <br /> Remodeling and/or repairing (describe)------- ---- ------------------------- ---------------------------------------------- ---------•-------------------------------•------------------- <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)------------------ ---- � r <br /> ----- ----------------- -------------------------- ----------------------------------- wr and/or Contractor) <br /> By ------ -------------- (Title)------------------- ------- <br /> (Plot plan, showing size of lot, location of system in relation o wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY- -- --- - -- DATE -` � <br /> REVIEWEDBY---------------------------------------------------------------------- -----------------------------•----------------------- DATE------------------------------------------------------------ <br /> BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE--------------------------------------------- --------------- <br /> Alterations and/or recornmendat ions------------ --- ------------------------------------------------------------------------------------------------------------------------------------------ <br /> ------------------------------------------------------------------- -------- ----------------------------------------------------------- ----------------------------------------------------------------------------- <br /> --------------------------------- ----------•---------------- - ---------------------.----------------------------------------------------------------------------------------------------------------------------- <br /> ------------ ---------------------------------- ------------------------------•---------- - ------------------- ------------------------------------------­------------------------------- -------------------------------- <br /> aFINAL INSPECTION BY: r <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hasetion Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> F.P.CC. <br /> t_ � <br />