Laserfiche WebLink
FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> - - -------------- ----------- --�����-7---- <br /> (Complete in Triplicate) Permit No. <br /> This Permit Expires 1 Year From Date Issued Date Issued __ X11 <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION ------211,5Q _,____LoQjv ford___--CENSUS.,,TRACT _-._$ - ------- <br /> Owner's Name Name -------Dona1d__A_.. -and---S.tax7.en.e---L•pe-1't------------------------- -Phone_365:79Q7_2---------- <br /> Address <br /> 368-=90 2---------- <br /> Address ----1.05.--S-o--ut-h--S_unset- St_reet-------------------------- -----------• City ------Lodi,___CA <br /> -------------------------------------- ---------- <br /> Contractor's Name ---------- -------------------------------------------- <br /> -------------------------------License # ----- - --------------- Phone ------------------------------ <br /> - <br /> Installation will serve: Residence ®Apartment House°E] Commercial :❑Trailer Court ;❑ <br /> Motel ❑Other -- ------------------------_-------------- <br /> Number of living units:____.------ Number of bedrooms ---_ ----Garbage Grinder ---- Lot Size ...5__aCrQS-----_---------------- <br /> Water Supply: Public System and name --------------------------------------------------------------------------------------------------------------Private <br /> Character of soil to a depth of 3 feet: Sand'[] Silt❑ Clay ❑ Peat ❑ Sandy Loam ® Clay Loam <br /> Hardpan ❑ Adobe-❑ Fill Material ------------ If yes, type ---------------------------- LA <br /> t � <br /> D <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK'1. 3 Size_�57_-t__/_0_-e�_-__-_-__---______ Liquid Depth X_.-:----------------- <br /> Capacity <br /> -___-_-____-__.Capacity&_n-.--_--- Typ -- Material No. Compartments _ --------------- -- <br /> Distance to nearest: Well re-�---------------------------Foundation ___ '_-_---_--_ Prop. Line _,Jl <br /> LEACHING LINE [ ] No. of Lines _03---------------- Length of each line------�7-0__-___-.______ Total Length - -. -.Q-.--..-------_ <br /> 'D' Box ?._- Type Filter Material _ i-, -----Depth Filter Material ............... ........ j <br /> Distance to nearest: Well ----R-'----------- Foundation ------------- Property Line ----5-`-------------- ' <br /> SEEPAGE PIT [ ) Depth ------------- Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No ,0 <br /> Water Table Depth ------------------------------------------------Rock Size ----------------- <br /> Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line _---------_-------- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------) <br /> SepticTank (Specify Requirements) -------------------------------------------------------------------------------- -------------:----------------------------------------------- I <br /> DisposalField (Specify Requirements) ------------------ ----------------------------------------- ----------------------------------------------------------------------- <br /> ---------------------------------------------------------------------------=------------------------ <br /> -------------------------------- <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have.prepared this application and that the work will be done in accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the following: <br /> "I certify that in the performance of th wor for which this permit is issued, I shall not employ any person in such manner <br /> as to becomM�� <br /> ct tm n' Co ns ' ornia." <br /> Signed -------- -- ---- --------------------- Owner <br /> BY ------------------------------- ----- ---------------------------------- Title ------------------------------------------------ <br /> ---------------------- <br /> (lf other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BYBATE <br /> ------------------------------------------------------ ��-- ----------- <br /> BUILDING PERMIT ISSUED --------------------------------------------- --DATE -- ---- ----------------------------------- i <br /> ADDITIONAL COMMENTS - <br /> ---------- --------------------------------------------------------------------------------------------------------:---------------------------------------------------------------------------------- <br /> --------- ------- -------------------------------------------------------------------------- ------------------------------ ----------------------------------------------------------------------------- <br /> -- -- / ---= <br /> - <br /> --- ------------------------------ <br /> -------------------------- -- <br /> ---------------------------------=----------------- -----Final Inspection by: _ Date � 'r - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />