Laserfiche WebLink
FOR OFFICE USE: <br /> Jamil- ,--------- ------------ <br /> ----------------------------------------- ------------ APPLICATION FOR SANITATION PERMIT Permit No, <br /> -------------- ---------------------- ------- (Complete, in Duplicate) <br /> This Permit Expires I Year From Date Issued Date Issued ��Q6 <br /> 113 - dCcD -�s'�� <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 com liance with County Ordinanc No. 549, hl <br /> JOB ADDRESS AND L ATION__-7 <br /> OwnersName /' ---------------------------------------------- -- ------------------------------ ---------- Phone------------------------------------ <br /> Address ------- ---i ----------- <br /> --------------------------------------------------------------------------------------------------------•----------------------------------- <br /> Contractor's Name----------00'�*/ -0";;�O ------------------- <br /> -------------------------k -•-------__- --------------------- Phone---------------------------------- <br /> Installation will serve: Residence 'Apartment House [] Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: Number of bedrooms *1_ Number of baths X-_ Lot size __Q_tv_ "+'______________ ----------- <br /> Water <br /> __-______Water Supply: Public system ❑ Community system ❑ Private 9+"reh to Water Table' <br /> C] E] t <br /> tt. <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 [1° New Construction: Yes 5j�—No ❑ FHA/VA: Yes P— No Q <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_"®: _ _Distanncce from foundation___, -`,0 -_ <br /> No. of compartments-----?--------------- de th__-___ <br /> Disposal Field: Distance from nearest ell_.lIS 4V Distance from foundatifjn__Z_4__ _-_.Distance to nearest lot line___��___--. � { <br /> Number of lines-------- ength of each line____ t _________________Width of trench____ __________,_______._ <br /> � <br /> Type of filter material___ -_- Depth of filter material__ '0 _.Total len th__ i <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line__---- ____ --_ 0, 'tt <br /> El Number of pits----------------------Liming material---------------------- Size: Diameter-----------------------Depth--------------------- --__-- r <br /> Cesspool: Distance from nearest well------------_____Distance fromfoundation------------------..Lining material----.-_________-____-_______________El - s <br /> Size: Diameter----------------- --------------------De th--------------- ----` --- _ _ - -- --------------Liquid Capacity gals. <br /> Privy: Distance from nearest well___________________-___________-___.'-----.....Distance from nearest building--------------.____- N <br /> ❑ Distance to nearest lot line__________________________ `� -! <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 rules and regulations of the San Joaquin Local Health District. t <br /> gg <br /> (Signed)----------------------- - -- --- -------- (�or Contractor) l <br /> _-_Title __ . <br /> (Plot plan, showing size of lot, location of syste relation to wells, buildings, etc., can be placed on reverse side). i <br /> E <br /> OR DEPARTMENT USE ONLY ;l <br /> APPLICATION ACCEPTED BY __. ___. _______ DATE______.' <br /> REVIEWEDBY -------------------------------------- ------------------------------------------- DATE------------------------ -i <br /> ----------------------------------- <br /> BUILDING PERMIT ISSUED---------------------------------------------------------- ------------------------------------------- DATE------------------------------- -----------------: <br /> `Alterations and/or recommendations:------ ---- ----- ------ ---------------- <br /> 11 <br /> - -- t .� --------------------- -------------- ----------- <br /> ------ - - - ---------------------p --- -- - ----f------- f- ----------------------- <br /> --------------------------------------------------------­---------- ------ '------'-------- - - ---------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> I INAL INSPECTION BY:.. Date----- -------- <br /> SANf <br /> r <br /> JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E,Ma:elton Ave- 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi, California Manteca,California Tracy,California <br /> r.a.❑o. <br /> 4 <br />