Laserfiche WebLink
FOR OFFICE VSE: ' <br /> i APPLICATION FOR SANITATION PERMIT <br /> Permit No. ...1..iz...!••l <br />------------------- - (Complete in Duplicate) a A7I . <br /> f¢. _- 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 compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION..-1K. ...... P _..,L ?l�!. %....... <br /> Owner's Name........ ..... .............................--........................................................ Phone.................................... <br /> Address_... ---.-. SE .CCL-.._... '-•--••......•......... ..................................... <br /> Contractor's Name--- --"-------"----------------"------------•----•------•-•-----•---.....---••----•-•-•--•--- Phone................................... <br /> Installation will server Residence❑ Apartment House ❑ Commercial Eg''frailer Court- ❑ Motel ❑ Other ❑ <br /> Number oNiving units: _`". Number of bedrooms._.-' Number of baths -A- Lot size '•-•---•-•-- <br /> Water Supply: Public system M<ommunity system ❑ Private ❑ Depth to Water Table .,iO ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay❑ Adobe Qg- nardpan ❑ <br /> Previous Application Made: (If yes,date--------------------) No ®'' New Construction: Yes gg--No ❑ FHA/VA: Yes ❑ No Q­ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: DI3ta�ee from nearest vlh---"""'...Distance frn founds ion / Material-e.ial_ :�—�. / .E A'"'.-:�'.......... <br /> p� No. of compartments......A-______________Size---4- A---40. Liquid depth__- ----------Capacity.- -�O...... <br /> Disposal Field: Distance from nearest well__"_"'"-_"._Distance from foundati n... f.J.......Distance to nearest lot line..47......... <br /> Number of lines.......o&-..�------"-`---,-�--,r-Length of each.line..... ......._.____.Width of trench._......._........._....... <br /> Type of filter material.,-e12 Depth of filter material.._fe�_..........Total length.....*. ...................... ..... <br /> b4 r <br /> Seepage Pit: Distance to nearest <br /> well---- _-__-_-Distance from fou dation.._.. --.-•_Dista`e to nearest lot line................ <br /> Number of pits.....A..._.._....Lining material_ ,.Size: Diameter___.�.�_........,Depth...ort� s�................. <br /> Cesspool: Distance from nearest well-----------------Distance from foundation___.._"-_,_---.___-.Lining material..................................... <br /> ❑ Size: Diameter-------------------------------------- - Liquid Capacity...........................gals. <br /> Privy: Distance from nearest well________________________________________________Distance from nearest building------------------------------------------ <br /> ❑ Distance to nearest lot line------------------------------------------------------------ ........--- .......--...................................................... <br /> Remodeling and/or repairing (describe):--------- ----•A� ----+�''T�:. .., ....... ..... <br /> ;....... <br /> ------------ --------------------- --- --------------------------• • <br /> I hereby certify that 1 have prepa d this applic ion and that the work will'bw done in accordance with Sen Joaquin County <br /> ordinances. State laws,prid,rules and regulations of the San Joaquin Local Health District. <br /> r Contractor <br /> (Signed)------------- - `�'..----- - ------------ ---------------------------------- (e ) <br /> B • ------------------------------------------------------------- ----- �G lrtle). . <br /> (Plot plan, showing size of lot, location of sy in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY............................................................... ..JN: (•-C'-•--. DATE---------- -• ---- -------6-"•------------------- <br /> REVIEWEDBY----------------------------------------------------------------------------------------------------- ••-•-------........... DATE------•---•----•---------•----------.--._>................. <br /> BUILDINGPERMIT ISSUED..............................................................—...................................... DATE....................................... <br /> Alterations and/or rete mendations:..-__. -• ......•... <br /> 1 ...�C._.. -� .. .. ---•---•--- <br /> r-- <br /> FINAL INSPECTIONDate.ceAQUIN <br /> 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 /> +' Ep 9 REVISED 8-89 RM 8-61 ATLAS _ <br />