Laserfiche WebLink
44 FOROFFICE USE: -ow .­­ <br /> A <br /> ----------- ---------- )----- ---I------------ <br /> ' <br /> 4'.3------- APPLICATION"-FOR SANITATION PERMIT Permit No. /Z/) <br /> -------------------------------------------------- <br /> (Complete in Duplicate) <br /> - <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 install the work herein described. <br /> This application is made in complianc-e with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION..._-..._..__-- <br /> - <br /> ----------- 06=�e4 ---- --- ............................... <br /> Owner's Name...------ <br /> ............. ------- --- ------- --- ------------­ Phone--------------................... <br /> Address............... <br /> Lle/iv_J!------------------;;�-----------_- ----------------------------------------­----------------*--------------*............ <br /> Contractor's Name..... <br /> -----------Voub------------------------------------------------------- Phone.............__................. <br /> Installation will serve: Residence 0 Apartment House E] Commercial Ej Trailer Court 0 Mofe*1 E] Other [3 <br /> t <br /> Number of living units: Number of bedrooms Number of baths Lot size ----------- <br /> . ....... ...... <br /> Water Supply: Public system E] Community system El Private W Depth to Water Table ------- <br /> Character of sail to a d'epth of 3 feet- Sand4o Gravel E] Sandy Loam Clay Loam El Clay Cj Adobe(3 Hardpan,0 <br /> Previous Application Made: (if yes,'date-------- -.--_I No Pa7 New Construction: Yes El No E' ] FHA/VA: Yes 0 Nob <br /> TYPE OF INSTALLATION AND SPECIFICATIONS-. <br /> (No septic tank or cesspool p6irmitfed if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well---------------- Distance from foundation-------_-----------aater;al,------------------------ <br /> k El No. of compartments------------------------_Size------_------------------._Liquid clepth----'­!".---------------Ca aci <br /> ....................... <br /> Disposal Field. Distance from nearest well--., _----Distance from foundation......r_,0_._.:D1 ;s'66nce to nearest lot line,__5 .... <br /> Number of lines'-I '._ _Length of each line---------- -------tW;dtk of french---- <br /> Type of filterI material.-._ __Depth of filter material---------2__P__'_TotaI length------- ---------------- <br /> Seepage Pit: Distance to nearest well-.....__.__- Distar;Z51%from foundation...............!_Distance to nearest lot line-..._..-_--..._ � <br /> ❑ <br /> ine--------_------ <br /> El Number of pits----------------------Lining material.-..;4-----------.-Size: Diameter"__.----------------Depth.----------------..._-........._. <br /> Cesspool: Distance from nearest well.................Distance from foundation... ----------'--_Lining material <br /> 11 Size; Diameter--------------------------------------Depth--------------- 011--------------------- -----Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well-................................_----------....Distance from nearest building.-.--------_...._-_.-__.__.......Distance fo{nearest lot lines-�+ <br /> ._. <br /> ----------------•-------.---- <br /> i <br /> --------------- I------------------ ......t­- <br /> Remodeling and/or repairing (describe):--------------------------- 4P_ L..( <br /> ---------------------;i;------ ------*.... ----------------------------------------------------_--........... <br /> -----------...........................a.........................I--------------------- ..........0----- .11sp - 1: . <br /> I .71 ----------------------------------------------m----------------------------------------------------------------- <br /> --------------I--------I------- ---­-­--------1_..._..-------•......----...._..40 <br /> ---------------------------------- -- <br /> ---- --- ---------------------------------------------------------------- ------- <br /> ------------------------------------------------------ - <br /> ------------------------------------- .......................------------------ ------------------------------------------------------------------------------ <br /> I hereby certify fh*at I have prepared this applicatic7n 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 /> -- --ofd -- ------ <br /> (Signed) .........aA__9__ <br /> ------------------------------------------------------------------ ------------(Owner and/or Contractor) <br /> 4�vy_------------------- <br /> Adings, etc., can be placed an reverse side). <br /> ---------- �? itle) <br /> Of .7............(T ------------------------------------------ -- ---------------- <br /> (Plot plan, showing size t, ocafi s em n r 1! to wells, bu <br /> FOR.JYEPART�ME�NT US f ONLY <br /> APPLICATION ACCEPTED BY . ................ - - ----------- ------ <br /> - - - ------------ DATE_ <br /> REVIEWED BY------------- <br /> i <br /> -------------- -- -- ----------------_--------------------- ­ <br /> 1_/-------------- ---------P... DATE_--------- ----- -----------------_ <br /> BUILDING PERMIT ISSUED-------------------------------------------------------------—----------------------- -------------- DATE--------------------_ <br /> Alterations and/or recommencrations- ---------------- -----_---------------- <br /> ------------ --------------------------------------------------I---­------------------I-------............................................................ <br /> ------------------------------------------------------------------I-------------------­------------------------------------------------------------------------------------------------------------------------------- <br /> ..........-------------------------------------------------------------------------- -------------------------------------------------------------------------- -­------------------ ----------------------------------- <br /> ----I--------------------------------------------­------------ ------------------------------------------ ------------ ------------------------- ----------------------------­--........................................ <br /> .................... ------------------------------------------------ --- -- ----------- -------------------------------------------------------------------------- ----------------­­-- -------------- <br /> FINAL INSPECTION BY:....... - -------------------- Date ... <br /> ------------- <br /> 2 <br /> ---------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> iF <br /> 130 Sobfh American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street <br /> Stockton,California Lod[,California Manteca,California Tracy,California <br /> Ei 0 ARV[SE. B-891 VM 0-61 ATLAB <br />