Laserfiche WebLink
FOR OFFICE USE: <br /> --------------- <br /> ----------- - APPLICATION FOR SANITATION PERMIT Permit No. <br /> - -- ----- "`r I --- - -- (Complete-in Duplicate) 8' <br /> _ __.___ _ ----------- __ This Permit Expires 1 Year From Date Issued <br /> Date Issued .o�__'r�..-_____ <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 complian with County rdinance No. 549. <br /> JOB ADDRESS AND LOBATION = .- - .------------------- ----------- <br /> Owner's Name----- �_/-� __________ _____ � �/ _ Phone. <br /> Address --- Tvh'410... -i11���----- _h. <br /> Contractor's Namel --•-R.�_ _ r Phone�.0��Q _ . <br /> - - ----------------- ------------------------- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other 2( <br /> Number of living units: 1____ Number of bedrooms -;L- Number of s -------- Lot size _t�-____-----�_ <br /> Water Supply: Public system ❑ Community system ❑ Private PrDepth to Water Table ------ - ft <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> Previous Application Made: (If yes,date_.----------------- ) No ❑ New Construction: Yes ❑ No FHA/VA: Yes [] No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: s <br /> (No septic tank or cesspool permitted if public ewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well Distance from�foundation---lQ------- . Leri I -y�'tp <br /> No. of compartments,2___________________Size_�j�_&.TA_e-..�_ 3Liquid depth_ *__-_. Capacity__/,.ZrO_ <br /> Dispos I Field: Distance from nearest wel�__�Distance from foundation-____e Distance to nearest lot line______ _______ <br /> Number of lines___ :.......... . ...Length of each line-- 9---—4 ­ of trench ---- <br /> Type of filter material Depth of filter material_.__ Total length_____________Zi�2 _ ______.. <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 /> _..___._._._ <br /> El Size: Diameter. = - Depth - - Liquid Capacity gals.�. <br /> Privy: Distance from nearest 'e 11 <br /> from nearest building----------.__________________-...__._- <br /> ❑ Distance to nearest lot line'------------- ------------------------------------------------------------------------------------------- - <br /> Remodeling and/or repairing (describe):-------- ----------------------------___ <br /> 0--"- <br /> ------------------------------------------------------------------------------ <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 /> ordina e , ate laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)- "' '�` ----- ------- ---- ... - ------ ntractor <br /> By:------------------------------------------------------- -------- - ------ ------------ -----------(Title)--------------- ------ ------------- --- ------------- - <br /> (Plot plan, showing size of lot, location of system in relation to wel , building , etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY- :DATE------177!4 <br /> 6.18 <br /> REVIEWEDBY ---- --- ------------------- ------------------------- -------------------------------- DATE------- ------------------- <br /> BUILDING PERMIT ISSUED---------- --- --------- - ---- - --------- --------- DATE - <br /> / o t - ---- -- .._1Qk- - ---- <br /> era+ons nd or recommendation :. <br /> . <br /> ... 'r.AR-'------------------------------------ --------------------------------------------------------------- -------- <br /> --- <br /> ------ - --------- - -- ----- ------ - -- -- -- <br /> - ----- - - --- <br /> - - <br /> FINAL INSPECTION BY:..._ --- --------- Date-------9,-5-(09 <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haipiton 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 />