Laserfiche WebLink
FOR OFFICE USE: <br /> -------------------------------------------------------- <br /> APPLICATION FOR SANITATION PERMIT" Permit No. _.Z __'7--_..-._ <br /> -------- ------------------ --------------------------- (Complete in,Duplica#e} `` <br /> ------ ------------------- This Permit Expires I Year From Date Issued Date Issued ____._1--l-. ___ <br /> r. <br /> Application is hereby made to the San Joaquin Local Healfh District for a permit to const and i st 1 the work herein describe: <br /> This application is made in compliance with County Ordinance No. 549_ [JL <br /> JOB ADDRESS AND LOCATI `J 03.5 � ' <br /> 7G P <br /> IL <br /> � . � ' <br /> Owner's Name---- 'r�N S ----------------------------------- <br /> --------------- <br /> Address <br /> ` ' <br /> -------------- <br /> Address <br /> Contractor's Name-----------------------------------------5-jf-F------- -- ---------------- . ..__ PPhonnee.. <br /> -•-.------•----•--------•_-----------•-•------- ---- ..- -------------- `+ 4 <br /> . h ..............-------------- ;• , <br /> Installation will serve: Residence N Apartment House ❑ Commercial ❑ Trailer Court E] Motel Other ❑Motel :1 <br /> Number of living units: ____l_ Number of bedrooms . �_ Number of baths ___L__ Lot size ........ <br /> Water Supply: Public system q Community system ❑ Private ❑ Depth to Water Table ________ ft. <br /> Character of soil to a depth of 3 feet: 'Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan [] <br /> �j <br /> Previous Application Made: [If yes,date--------------------1 No New Construction: Yes No ❑ FNA/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 /> Sep is Tank: Distance from nearest well-----------------Distance from <br /> foundation--------------- <br /> ----Material_____- <br /> o compartments <br /> a <br /> ----Size------------------------•-------Liquid depth-------------- _Capacity <br /> ... <br /> Disposal Z Id: I Distance from nearest well------------------Distance from foundation.....................Distance to nearest lot line___________ ?° <br /> Number of lines-----------------------------------Length of each li.ne-------------'-----------------Width of trench------------------------------- <br /> Type <br /> -_.-------•-------- -- <br /> Type of filter material-------------------------Depth of filter material-----------------------Total length------------------------------------- <br /> r - ww , <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line---------------- <br /> ` •4 <br /> ❑ Number of pits-----------------------Lining material-----------------------Size: Diameter--------------------- Deptk-- --------------•----- <br /> Cesspool: Distance from nearest well _______--_Distance from foundation--------------------Lining material--------------------------------- ---- <br /> ❑ Size: Diameter - Depth = ------------------------------Liquid•Capacity---------------•-•----------g ls�W.' <br /> Privy:{ Distance from nearest well------------------------------------------------- from nearest buildingrf KI I <br /> ❑ Distance to nearest lot line"- --------------=--- , <br /> Remodel' g and/or repairing describe).: ____t <br /> . ---_-_- _- <br /> !�:--- S <br /> ----------------------- --F <br /> ------------------•--------------------- s <br /> it,ru ' <br /> I hereby certify that I e pre ared this application and that the work will be done in accordance with San Joaquin Count <br /> ordinances, State laws, nd les and regulation the San Paquin L ealth District. %- <br /> (Si 9ned ------------- ----•--- - ------------- --------4ZF -------------- {Owner and/or Contractor ;f <br /> g ------- -- <br /> y� ------------------( } - _------i-: ,} <br /> Title <br /> ----------------- <br /> (Plot plan, showing size'of lot, location.of system in relation to.wells,-buildings, etc.,.can be placed on reverse side. ' <br /> j <br /> FOR DEPARTMENT USE ONLY <br /> a <br /> APPLICATION ACCEPTED BY---------- - DATE ..^^��� p <br /> REVIEWED BY 4;; -�----------� f <br /> --------- -------------------"---------------- ------------------- DATE. <br /> = . <br /> ;,t. <br /> BUILDING PERMIT ISSUED---------------------------------------------------------------------------­-------------------... RATE = <br /> Alterations and/or recommendations:-- - , ; ' <br /> ' t•- wry - <br /> -"-----------------• --•------------------- ------•--------•---- ---------------------------,------------------,--------------- ---- -----• ------------ <br /> •---- <br /> -----•----------------------------------•-•----•-•------- ... <br /> ----------------------- <br /> - ---- = = <br /> ----------------------------- <br /> FINAL INSPECTION BY___________________ _ Date <br /> - ----------------------- ----------- ------ ------------------- ------------------------------------------- •r=: "'. � <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT :; <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 4th Street h9. <br /> Stockton,California Locil,California Manteca,California <br /> Tracy,California <br /> EE-9 REVIeEC 8.59 F,P,CO.2M 6.60 <br /> P <br />