Laserfiche WebLink
77 777 <br /> ARRLICATION FOR SANITATION PERMIT *' Permit No. •!�_�------- <br /> .� (Complete in Duplicate) <br /> 42 .� Cr Date Issued <br /> Application ishere y made to the.S o qui local Heal strict for a permit to construct and install the work herein described. <br /> This application is made in compliant wit ounty Ordinf�nce o. 549. <br /> a ; <br /> JOB ADDRESS AND LOC . ......-= O7 ..�C1 <br /> Owners Name.._.. --•- --- . ---••-•. _ i - ------------ ........................_ Phone. '�"�.�.��_.. <br /> Address -------- '�� t ----- - <br /> Contractor's Name •tom - ` f t +T ----- Phone. -----::- � <br /> Installation will serve: Residence Ej Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other <br /> Number of living units:'J____ Number of bedrooms --I— Number of baths Lot size -. I_?•!5...•.. �....___... <br /> Water Supply: Public system SK,. Community system ❑ Private,K Depth to Water Table ! ft. <br /> Character of soil to a depth of 3 feet: Sand n Gravel ❑ Sandy Loan}❑ Clay m ❑ Ay'❑ Adobeo Hardpan ❑ <br /> Previous Application Made: Yes ❑ Nox_ New Construction: 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_ ©''`_---- Distance from foundation 4.0-------.Material.. te.4`c2.� <br /> Pi No, of compartments__.._----_�__.__-Siz 7: ~.'�---Liquid depth-%.4:%7ii.---.•.--Capacity.- 2"0.�!�'' <br /> Disposal Field: Distance fromnearestwell S.O .-.Distance from f undation /Q' Distance to nearest lot lme l r__ <br /> Number of lines._./ ____-_ Length of each line..... Width of trench_„" f !! <br /> Type of filter material.-� Depth of filter material•_,f g'�_' Total length------ <br /> r / S^ter <br /> Seeps a Pit: Distance to nearest well- J Ql0-_.______Distance f o foundation ..__..Distance to nearest lot line-- _._V„ <br /> Number of pits,..1------------ Lining materia L_Size: Diameter.---•A-3-op 3.........Depth--- d o� .------ <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material--------------------------------- <br /> Size: <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 <br /> - -_--•-----------Remodeling and/or repairing (describe)------- -- ----------------- ----- -------- -------- •------- -----•-• ----- -------. ---- ... •---------------- <br /> -----------------------------------7.. ..........-------•-- .------ ----- •------ ------- ----- ------- -------- -------- -------- ------- - - ---- ------------------ <br /> I hereby certify that 1 prepared this appli ' n and that the work will be done in accordance with San Joaquin County <br /> ordinances, State law rule nd regulations the an Joaq Local Health,District. <br /> ... � � .!! _:�: ------ /''".,_----- ,.. <br /> ------ <br /> (Signed) "` ---- -- { r G #Tactor) <br /> (Plot plan, owing size of lot, locat 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 /> REVIEWED BY - --- - --------------- - - DATE. .9�, <br /> BUILDING PERMIT ISSUED.--- --- -------- -----------•---------- ---- --- -- ------ DATE--------9f ------------------------ <br /> Alterations <br /> -------- --- - <br /> Alterations and/or recommendations:-- ------ ---------- ---------------------------------------------------------------- ------------ " -------- ----- ------------ <br /> -------------------------------- -------- ------ •--------- <br /> FINAL INSPECTION BY.-t�- -R---------- Date- `- �--------------- --- --•---- - ----------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C"Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M 8-51 Revised W-2100 <br />