Laserfiche WebLink
Metadata
Document management portal powered by Laserfiche WebLink 9 © 1998-2015 Laserfiche. All rights reserved.
FOR OFFICE USE: <br /> s f'------------- ��77 pp- <br /> r,-`�ll.li. .. <br /> -_____-________----_ � Lam_'__ -_- APPLICATIC*4 FC R SANITATION PERMIT Permit No. . _ . <br /> ------- ----- ... _. _ (Complete in Duplicate) r Date Issued <br /> i QQ <br /> - _ _-__-_.___ This Permit Expires 1 Year From Date Issued <br /> ._ .___/--.�� <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 D LOCATION--1/---6�-..--3---- <br /> Owner's Name _0.-.!1.....� J_. � _ ---- Phone-4.6(--RL/........ <br /> Address ----•------------------•- •-•----------------------------------------------------------------------------------------------•- <br /> Contractor's Name..Aq - 2!1. _ llJ2<sZ---•----------------- ---•----------------------•--------------•----- Phone.. <br /> Installation will serve: Residence CRI Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _f----- Number of bedrooms __Z._ Number of baths---I.... Lot size ----6f0"x ________________________ <br /> Water Supply: Public system [Z 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 [Z Adobe❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date------..----------- ) No ® New Construction: Yes ❑ No [0 FHA/VA: Yes ❑ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: ILA <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well_?___Distance from foundation--------------------Material _-.--.________-._.-:-.---.-_-_.---_.---__._---_. <br /> ❑ No. of compartments------------­­--------Size----­-------------------------Liquid depth--------- ------ ------- Capacity----------------------- <br /> Disposal Field: Distance from nearest well_/.11(_'._.-Distance from foundation..3V..........Distance to nearest lot line.lo-'....... <br /> ® Number of lines---------�_.. ----------Length of each line_ -------------Width of trench- <br /> _..PZ.q_"..------------------ <br /> Type of filter material-_-:!t__�?.�'/C__-Depth of filter material---Ae'. ----Total length----.3_Q_'____ ________________­ <br /> Seepage Pit: Distance to nearest well---/QU`_ _._._..Distance}4om foundation-70.G'_.-_.._.Distance to nearest lot line_--1 ------- <br /> Number of _ ---------­-- <br /> ® p lLining material--9(0;:'_e__-_ Size: Diameter._3-3"_____-.Depth-_;7-,.�`-_-------_.--_.-- <br /> Cesspool: Distance from nearest well ----------------Distance from foundation--..------------- _.Lining material_-.-.-_.-.-.-----_-.-__-_-______---_ <br /> ❑ Size: Diameter- -- -------------- ---- -----------Depth-------- ------- ---------------------------- ---- 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):----&e__6 1 �xz� . <br /> -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <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,j�and rules and regulations of the San Joaquin Local Health District. <br /> = - ---------------------------•- -------- --------------- - -------(Owner and/or Contractor) <br /> By: ----­A�---` ----------------- - ------------------ -------------(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 /> BUILDING PERMIT ISSUED---------------- ---------------------------------------------------------------------------------- DATE <br /> Alterat�s and/or recommendations: --_ � -- -• --- <br /> `S /�?------------ s 1iti s'�� ieait°i.4 ,tr <br /> �° f �40 -47 <br /> p jp <br /> ...................------- 4: --',.i/----- ----`-- -- --------------------- �..- -- ---------------------------------------­------------------ <br /> d <br /> FINAL INSPECTION BY:....---------- — ------------------- Date------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi California Manteca,California Tracy,California <br /> E.H.9 2M 1.67 Vanguard Press <br />