Laserfiche WebLink
I <br /> FOR OFFICE USE: ' <br /> ------- -- --------- ------------------------------------ <br /> ...... <br /> .- -_.to <br /> - - APPILICATION FOR SANITATION PERMIT Permit No. .__ _ 1 � <br /> ..---- 1- - o-------------- --------- (Complete•in Duplicate) <br /> 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+con tract and instafl the work herein described. <br /> This application is made in compliance with County Ordinance No. s <br /> -- --------------------------------- ---- ----I ----------------------------- <br /> JOB ADDRESS&ANLOCATIO�N�_f __I_941A->_ _ ___________ �___._Owner's Name- ---_.W__�----------------------------------------- ----- - ------------------------------------- <br /> Phone.-- -- ----------------------------- <br /> Address------ <br /> Contractor's Name_- ?.-----1 T;S--- .. Phone------------------------------ <br /> Installation will serve: Re4dence EApairtment House [❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units:' )____ Number of bedrooms --- —Number of baths.-I---- Lot size _ ------- ------------- ---- <br /> Water Supply: Publics stem Community s stem Private De th to Water Table Zft ! <br /> PP Y= , Y ❑ Y Y ❑ �P <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Applica ion Made: [if yes,date-----------,....... ) No 0 New Construction: Yes ❑ No HA/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�Tank. g Distance from nearest well_________________Distance from foundation--------------------Material ---..___-_._...____...__________...__.__--__-_. <br /> I No. of compartments-- ---- ---- -------- - Size.------------------- -----------Liquid depth--------- ------ ---. ---Capacity---------------------- <br /> Disposal i Distance from nearest well._.._-_._Distance from foundation_ _._______._.Distance to nearest lot line___.. <br /> Number of lines._____I__________________---_--Length of each line__...7.Cp.'._____...______-Width of french.____ .�-__--__------.__. <br /> Type of filter material--- -----.__Depth of filter material....tr_"....__...Total length--------7 __---_____________________ <br /> Seepage Pit: Distance to nearest well.............._...___Distance from foundation-------------------Distance to nearest lot line----------------- <br /> El Number of pits--- ----------._'_Lining material--------------------_. Size: Diameter---------....----------Depth-------- ---------------.- <br /> Cesspool: Distance from nearest well ----------------Distance from foundation- ------------ ..Lining material-------------------.--------------- <br /> ❑ Size: Diameter- -- --------- ----- -------- ---Depth---------------------------------------------------Liquid Capacity----------------------------gals. <br /> i Privy❑•. Distance from nearest well---------------------------------------..........Distance from nearest building_---__-__.__._______________.__..___.._. <br /> Distance to nearest lot line--------------------------------- - ------- ------------------------------ <br /> Remodeling and/or repairing (describe):------ -'------------------ ------ --- -- --------------------------------------•-------------- •------------ <br /> ------------------------------------------------------------------------------ -------------------•------------------------------------------------------------------------------- ----------------------------------- <br /> ----------I------------- -------------------- •---------------------------------------------------------------------------------------------------------------------------------------•----------------------- ---- ---- - - <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, and rule nd regulations of San Joaquin Local Health District. <br /> (Signed) ----_-.Owner and/or Contractor <br /> By:---------------------------------------------------------------- ------------------ ------(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 /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED By - - ------- ------------------------------------------------ DATE._ -7 <br /> REVIEWED BY. ---------------------------- - ----- -- ------ DATE-- ---- <br /> BUILDINGPERMIT ISSUED-------- ---------------__ -------- ----------------------------------------------- -------------- DATE.--------------------------------------- ----------------- <br /> Alterations and/or recommendations: ------------- ---- --------------------- ------------------------------•-- ------------------- ------ <br /> ---------- ----- ---- -- -•--------------------------------------- - .._----•--------------------------•-------------------------------------------------------- --------- ----------------------•----------_._....._ <br /> ----------------------- ----------------- <br /> ----- -------------- ------- ---------------- ----------- ------------- ------- ------•---•--•----------•--•------ --------------------- -...._.------------------ ---- --...-- ---- -------- <br /> FINAL INSPECTION BY:. .._ W Date_.--1�-_.� =__ .... _..._. <br /> ------- - ------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hasellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street <br /> Stockton,California Lodi, California Manteca,California Tracy,California <br /> E.H.9 2M 1-67 Vanguard Press <br />