Laserfiche WebLink
rurc urrlc.t u5t: <br />-------------------------------------------------------- <br />----------------------------------------------------°-- r44PPLICATION FOR SANITATION PERMIT Permit No. .. � <br />-------------- ----------- -- -------------------------- (Complete in Duplicate) G <br /> Date <br /> This Permit Expires 1 Year From Date Issued Issued ....._... <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work ereindescrbed. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATIO --- --- -°" ` ._ Q.�„ e �� - <br /> Owner's Name .t ......._rf. . ------------------- •- ------------------------------- --- •----------------- Phone.................................... <br /> Address � � ----------••-- ------------------------- <br /> Contractor's Name.....1,6_ r!°`-------------------••---•-----------•--------------------•-------------------------------------- ............------ Phone---------------------•------------ <br /> Installation will serve: Residence RI Apartment House ❑ Commercial ❑ Trailer Court (] Motel ❑ Other ❑ �. <br /> Number of living units: Number of bedrooms __.>r_ Number of baths yle- Lot size Q d------------------------------------ <br /> I (6Y <br /> - -- -----------------•--- ---------------- <br /> Water Supply: Public system ❑ Community system ❑ Private E] Depth To Water Table .0?. ft. , <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [� Clay Loam ❑ Clay ❑ Adobe❑ Hardpan Q <br /> Previous Application Made: (If yes,date--------------------) 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 Tank: Distance from nearest well__S___ --------Distance from foundation.--/Q----.-------Material - �------------------------- <br /> No. of compartments-_---gn-----___-_----_Size#�3__� --c�__----Liquid depth------ Capacity.1.,Z 9:q------ <br /> Disposal Field: Distance from nearest well-.S—Q..........Distance from foundation_/_17------------Distance to nearest lot line._wr i........ <br /> J Number of lines--------g?------------------- Length of each line------- Width of trench....A-,Y-d.......... ........ <br /> Type of filter materia w Depth of filter material_--- '+___-----Total length----/1.Q-........----------------- ' <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation-----------._...___.Distance to nearest lot line................. � <br /> ❑ Number of pits----------------------Lining material------ ----------------Size: Diameter----------------------.Dept h--------------..-------_----- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material----------_------------------ <br /> El Size: Diameter--------------------------- ....Depth----------------------------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well-----------------------f--------------------.----Distance from nearest building-----------____---.:-_---___------_---.._. <br /> ❑ Distance to nearest lot line------------------------------------------------------ <br /> Remodeling and/or repairing (describe)---------------------------------------------------------•---•------------------•-••-----------•------- ----•------------------•-••---•-.----`� <br /> • ------- •-------•--------•--•----------------------••------- <br /> 4 <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, a . rul s and regulations of the San Joaquin Local Health District. <br /> Si .�{ gned) � --------------- ---------------------------------------------------------------_-----------(Owner and/or Contractorl <br /> By:----------------------- <br /> :--------••-•---------------------------•--------•---.. ------------------------------- -----------------------------------------(Title) <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----- ------------------------------•---------------------- DATE---- <br /> REVIEWEDBY--------------------------------------------- ------------------------------------------------------------------------•------. DATE------------------------------------------------------------ <br /> 80ILDINGPERMIT ISSUED------------------------------------------------- ------------—---------------------------------.---- DATE--------------------------------------- <br /> Alterations and/or recommend*ations:----------------------------------------------------------------•--- ----•------------------------------------••-•-------•-•--------------------•-------- <br /> ----------­------------------- --------------------------------- -I--------------------------------------•----•----------------------........-------------•-------•------••-------------•------- -------------•--- <br /> 0 <br /> --------------------------------------- ---------------------------- ----------- --------- ------------------------------------------------------------ ----------------------------------------------------------- lqz� <br /> FINAL INSPECTION BY:. . .--- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> E5 9 REWSE0 8-55 2M 5-62 ATLAS <br />