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 /> .. <br /> /7 eY e;4W �997-- -------------------------------------------------------------------- -------- <br /> JOB ADDRESS AND LOCATION.--- . <br /> Own er's Name--'S�_, - - ---------------------------- ---- --- ------- --- ---- -- ------ Phone--- <br /> r <br /> Address.----' <br /> ------------------------------------------------ � <br /> 'Contractor's Name- ..r - ''.tE ' ---- --- '4-----------------------------j- ---------------- Phone-----------_------- -'- <br /> Installation will serve: Res'i ante <br /> Number of livingun'its: __ Number of bedrooms j _-- Number of baths _[R Apartment House El Commercial E] Trai Trailer o;surt E] Mote! [-] Other E-] <br /> Number _zl_____________________--_..______ <br /> Water Supply: Public system (W Community system ❑ Private ❑ Depth to Water TableAO. ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam❑ Clay P Adobe ❑ Hardpan ❑ <br /> Previous Application Made (if yes date_______:____.___-) No Y New Construction: Yes � No ❑ FHA/VA: Yes ❑ No ❑ <br /> t <br /> , 1 <br /> TYPE OF INSTALLATIONAND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> p ° <br /> Se tie Tank: Distance from nearest well---NO!..---Distance from foundation__. __.Material_ �-------------- <br /> No. <br /> ._ _..._.No. of compartments----- _;2- Size___' XX= .-_Liquid deptl�h � �---- -_Ca Capacity / Z 1 <br /> r <br /> Dis o'al Field: Distance from nearest well JV0_____Dlstance„rom foundation_-_ r --.Distance to nearest lot line_. -���-------- <br /> Number of'lines:. i.*J_ __Length o� f each,lme - _-.Width of trench q2V ..................... <br /> 'j Type off filter material _ --- -----Depth of filter matenaL__1_ g---. .__Total length___._ 6�------------------I <br /> Seepage Pit: Distance to nea est;wel'I_ __I _.�...-__Dista)nce from foundation_--fU----------Distance to nearest lot line---- ` <br /> V\ <br /> Number of pits--- --------- A " a r as4 Depth I ^\ <br /> t p- t �..._ Lining mater�aL.�_��''_�____.Size: Diameter-_1330. p \ n <br /> Cesspool: Distance from nearest well -Distance from foundation-------------------.Lining material-_ -. .-------I----------- \ ! <br /> ❑ Size: Diameter-_-_ « Depth..__----------.---------------------------.--------Liquid Capacity_ ..---._-_-_--_---.--gals. <br /> Privy:. Dista"nce'.from'`nea�rersstt 6 w ._ __. Distance from nearest building-------------------------------- _. <br /> Distance to nearest lot line,;--- --- --- # ---- ---------- --_--- -------- ------ ---- - -•------- --- ---------- - -- - <br /> Remodeling and/or repairing (describe):•_____ ---- --- _ ° <br /> --------- # -----i <br /> ------------ <br /> - -------------------- <br /> _7-- --- ' •:• _-1-1--,- ----- - -------------- i <br /> I <br /> I�hereby certify that I have prepared this p a+ion and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws; and rules and regulations of.4the San Joaquin Local Health District. I d <br /> (Signedn {r --------------------------------------- . _ _ _ _ _____--------_(Owner and/or Contractor <br /> ) <br /> I By:----- <br /> :---4 <br /> 1As;-- .__. .. i _ Title, _ 1 <br /> (Plot plan, showing size of lot, location of syst' in relation to wells, buildings, etc., can be placed on reverse side). I <br /> FOR DEPARTMENT USE ONLY 1 <br /> I <br /> APPLICATION ACCEPTED BY_----A----- __ i-_____ -_ _----___________-_------------------ DATE.. <br /> REVIEWEDBY '----------------------------------- ------------------------------------------------- -- DATE - -------- <br /> BUILDINGPERMIT ISSUED-------------- --------------- '--------------------- -------•-------------------------------------- DATE------------------------ -------- <br /> Alterationsand/orrecmmendations---- ------ ----- --------------------------------------------------•-------------------------------- ------------------------•---------------------- -------- <br /> ------------- -------------------k------------------- ---------------­------------------------ <br /> --------- ------------------------------- ------------------••.---------------------------------------------------------------------------............ <br /> --••--••-I-------- <br /> ------------------------- '' ---------------------------- ----------------- -------------------------------------------------__--------------------------------------------------------------------------- ------ <br /> ? , ---------- --------------•------------- ------------------------------- -------- ------------------------ <br /> r <br /> I <br /> ---------'------------------------------- ---- ---------------------- ---------• -------- ------:-----------------------------------------.----------------------------- ---------- ------------------------------------- <br /> FINAL <br /> ------------------------ ------ <br /> FINAL INSPECTION --------------- .. _ Date--------- --------- ---------------------- e <br /> SAN JOAQUIN-LOCAL HEALTH DISTRICT 4 <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 /> 1 <br /> ,� I <br />