Laserfiche WebLink
FOR OFFICE <br />- <br /> ------------------iv----------------------------------- APPLICATION, FOR SANITATION PERMIT Permit No. . ..7......°2_--S <br />-----------------­­ -------------------------- {Complete in Duplicate) 1rC <br />-------------------------------- - ---------------•--- This Permit Expires 1 Year From Date Issued <br /> 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. <br /> JOB ADDRESS AND-LOCATION--------- .r-• -._; - :_ /1 CQ <br /> Q---------- ---•-- -- ----_---•-----Owner's Name------- ------ ---... <br /> Ph <br /> one <br /> Address..- <br /> -- v ---------------------------- Phone - `---- • <br /> Contractor's Name---- � <br /> Installation <br /> will serve: Residence_®�partment Houser[:]. Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ / <br /> "'Al-Number of living units: _/.• Number of bedrooms ..-� Number of baths .;l__ Lot size ---__.-_-`��_._ .. . <br /> Water Supply: Public system 2--community system ❑ Private ❑ Depth to Water Table�7_�_�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-------------:.......l No OR--_N_'ew Construction. Yes ❑ No Ej--�HA/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 /> ep' nk: Distance from nearest well-----------------Distance from foundation--------------------Material------------------....._.._.................._..__. <br /> No.' of compartments--------------------------Size.................. --------- __Liquid de th____________._____--- Capacity i <br /> Disposal Field: Distance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line.=_____.......... <br /> ❑ Number of lines___________________________________Length of each line------.-----------------------Width of french.______._....._..__:.-------------- ( , <br /> Type of filter material--- ---- Depth of filter material___________________-__Total length.......................................--- \ I <br /> Seepage Pit: Distance to nearest ell� _Distanc m f undation. .J�_�......Distance to nearest lot line----_5.�...- �u <br /> Number~of-pits_..-_ "'Lining material: __ _t.. '__._Size: Diameter.___--f/-- p <br /> Cesspool: Distance from nearest well----------------- from foundation--------------------Lining material..................................... <br /> ElSize: Diameter------------------ -.-_--:-:- .Depth.-:- --_----- ------------ ---------` - Liquid Capacity------------_-------------gals. �f <br /> Privy: Distance from nearest well __________________________________________......Distance from nearest building----------------------...........___.____. <br /> ❑ Distance to nearest lot line----------------------------- ----------------------------------------•-•---------------••-------_------•-------------•-•------------------- <br /> Remodelingand/or repairing (describe):----------`---- ------------------------------- ---------------------------------------------•--------------•-•-----------------•------._._.._.. <br /> ----------------------------•-----------------------••-----•-•----------•------------------------------------------------•----------------------_...-------------------------•---•---------------•-•---------------------- <br /> ----------------------------------•-----------------------------------------•-•-•-•-------------------•-------•---------------•-•---------------------------------------------------......----------------------------------- <br /> -------------------------------------- <br /> I hereby certi#y that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State ws, and rules and regulations/of the San Joaquin Local Health District. <br /> ------ zt #r 1 <br /> (Signed)------fzl---------------• -- j----------------1.3_...------------------------------------------------��•-�'ner and/or Contractor) <br /> By----------------------- .. �(-� 't_1_ z--- ^ •----•-•---•--••---------------- {Title].-•. v <br /> (Plot plan, showing size of lot, location of system in tion to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------- ---- --- J%t'-rte---•--••----•--------------- DATE-------- - —•------------- I <br /> REVIEWEDBY -------------------------------------------------••-------------------.- DATE------•------•-----•------•----•----------- <br /> _ -BUILDING PERMIT ISSUED ------- - ----------------- ------- DATE------- <br /> � <br /> --------------- <br /> o -- -- r_Alterations and/or recommendations:_- -!_3 <br /> ......................................................... -------------------------------------------------------------....--.-------------------------------------------------------------------------------------- ---•-- <br /> ------ ----------------- - ------- -- ----- -------------------- -------------------------------------------------------------------- <br /> s <br /> FINAL INSPECTION BY ... .- - - --=-- -- ----- -------------- -� <br /> Date-------------�=-- - -- --- ...-----------....-----_----- <br /> -x__3_�:.Cv <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT '? <br /> 130 South American Street 300 West Oak Street k 134 Sycamore Street ZOS Wast 9th Streit' ;I <br /> Stockton,California Lodi,California Manteca,California Tracy,caiifor,I6 <br /> ff <br /> E6 9 REVISED e•99 2M 8-61 ATLAS <br /> F" <br /> 1' <br /> - '0 <br />