Laserfiche WebLink
FOR OFFICE USE: <br /> --------------------------------------------------------- <br /> -------------___ .____._ .-. _--___--___.. APPLICATION FOR SANITATION PERMIT Permit No. <br /> -- --- (Complete-in Duplicate) <br /> Date Issued <br /> __ ---------- This Permit Expires 1 Year From 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 /> 17'SCS , <br /> ADDRESS AND LOCATION � j �5 �1 - 1�-' --- --------------------------------------k-�---`--I---�==�---------- <br /> ;1ee--------- ------------------ --------- ----- pp .2 <br /> Owner's Name--------- - -- ----------------------------- ---- Phone--- <br /> Address--------1•*7-.2-55__®-----•• ..T /`1 ' <br /> --------------- ---------- -------Name----- -------------------- Phone. ,,2 "�S oy- <br /> --------------- <br /> Installation will serve: Residence Apartmen ouse ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __ ._.._ Number of bedrooms Z. Number of baths_I____ Lot size ---_�.C-R-E-.1.9Gf�---------------------- <br /> Water Supply: Public system ❑ Community system ® Private ❑ Depth to Water Table ------ _ ft <br /> Character of soil to a depth of 3 feet- Sand P' Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date------------- No 19 New Construction: Yes ❑ No [e4HA/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 /> Septic Tank: Distance from nearest well_________________Distance from foundation_..____...___..____.Material .__._____-_____._._._..__ ...................... <br /> CqT,Tf nt& No. of compartments--------------------------Size-------•-----------------------Liquid depth--------- ------ ------- Capacity---.... --------------- <br /> Disposal Field: Distance from nearest well----- .----Distance from foundation-_-__l O_._____-Distance to nearest lot line-----s$-------- <br /> ( STI kG— Number of lines_--____--1.__.__ .. _. Length of each line___-----ZT_=_. __,,r <br /> Width of trench._ 2------------- <br /> �} /9 CD• Type of filter material----- Depth of filter material____ ____Total length-----------------7a._________--____ <br /> Seepage Pit: Distance to nearest well__._'_?--------Distance from foundation__..14.........Distance to nearest lotlir�e-----6-------- <br /> �] Number of pits---__/-_.--.._.__.Lining material-----Rq_dh-.__ Size: Diameter_FXL>(_;&pth.___.__._ . __.._.__.._..__._.. <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 <br /> --------------------------Remodeling and/or repairing (describe):---------------------------------------------------------------------------------------------------------•----------------------••-•-------------------- <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, and rulM and regulations of the San Joaquin Local Health District. <br /> (Signed)------ ------------ ------------------------------------•-------------------- ------- and/or Contractor) <br /> By:--------------------------------------------------------------------------------------------------=-----------------------------(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-_---- -- <br /> --------------------------------------------------- DATE---------3.� <br /> REVIEWEDBY-------------------------------------------- .--- ---------------------------------------------------------------- -------- DATE------------------------------------------------------ <br /> BUILDING PERMIT ISSUED---------- -------------------------------------------------------- ------ -__. DATE--------- --------------------------------------- <br /> Alterations and/or recommendations------------------ -------- --------------------------------- --------------------------------- ----------------------- ....... ----------------------------- <br /> ----- ---------------------------------------- -- ---------------------------------------------------------------------------------------------- <br /> ---------• ---------------------•------------------- --------- --------------------- ------------------------ --------------- ------------------------------------------------------- ----------------- <br /> --------------------:=------------------- ---- ----- -- <br /> Y�l <br /> FINAL INSPECTIO ........ C''r --�- --- ---------- �i 'Gr// 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 />