Laserfiche WebLink
FOR OFFICE USE: `. <br /> APPLICATION FORSANITATION PERMIT Permit No. .... <br /> } r <br /> f fir: <br /> (Complete in Duplicated <br /> --- --------------- .......41A 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 construct and install the work herein described. x <br /> This application is made in compliant. with County Ordinance No. 549. <br /> 15 2�7 <br /> JOB ADDRESS AND LOCATION--------- -------! --- l�kx �/__,_✓- _---- s��---/ �l".N1`�f_.__ �� isy .�3�'`�� <br /> R <br /> Owner's Name ._ - .-08'`1----I fD-C <br /> - - ° <br /> Address _ <br /> T 11 �? ��•-------- -- ', -----------------------------------------------------------------•---- <br /> Contractor's Name---------- _.., i4.�F'�p f f----- ��r?�il� Si�zt! -------7n_,�=------------------ <br /> Installation <br /> ----_.Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> �" ------------- ----------- <br /> Number of living•units: __/__ Number of bedrooms___ Number of baths _____"__ Lot size __"-_.-____G�___ ___._ <br /> Water Supply: Public syste [:1 Community system ❑ Priv ale pDepth to Water Table ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel E] Sandy Loam ❑ e lay Loam j@ Clay ❑ Adobe❑ Hardpan ❑ <br /> Previous Applica _ <br /> tionlMade: llf yes,date_-------- No Q New Construction: Yes D"*"No ❑ FHA/VA: Yes ❑ No Ej-- <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is av ailable within 200 feet.) <br /> Septic Tank..--- istance-from nearest we1I_, r'p-__.Distance from fo-ridatioq_��_____-___Material-77i4'���5�____:______-_- . <br /> �. <br /> i ] No. of compartments_.__ Size�X_ _- ,,----:--Li uid depth__•� ---------------Capacity.�� fa-- f Cw <br /> I <br /> i <br /> 10,A <br /> Disposal Field: Distance from nearest well-._/.,Ir��_--_Distance ;from foundaton _.____,_Distance to nearest lot line. ,G94____. {� <br /> --__---- --'- --------------Length of each lihe_,'�E_p=�'5`' e_-Width of trench_-.�`!�_��-------------------- <br /> ------------ <br /> ----------- � <br /> Number of lines_____ f_ ,t - <br /> Type of filter material-S GP :.____Depth oftfilferrrn terr.ial—/ _ .-___.__Total length c2r ✓--------- -------- <br /> Seepage Pit: Distance to nearest _..___Distance from founda#ion_�D_'f---..___.Distance to nearest lot line_ <br /> © ( Number of pits--_-__�:___--_-__-Linin g material- �.f"-'�_ Size: Diameter-_ -i1-__---___Depth_.-..;Z 5._...___-_________ <br /> 4 ' <br /> i <br /> cesspool:.. Distance from' nearest well___-------------Distance from foundation__.--------------Lining material__._.___________-_---_--__-_____--___. <br /> ❑ ~,­.' Si-2n�Diameter- --------------------- ..--,Depth -------------------------------------------------Liquid Capacity----------------------------gals. <br /> Privy: ,Distance from nearest well-_-__. -------------------------Distance from nearest building_____________ --------------------------­ <br /> . ------------------- <br /> ❑ --------------------------••---------•-- <br /> Distance to nearest lot line--------- -----------------=- ---_- - <br /> /� Lf! <br /> Remodeling and/or repairing (describe): �- ------�- >5r�' �'------------•----------�-------------------------------------------------------------- <br /> 4 <br /> ----°------•------------------ ------------------------ <br /> %_� --•--------•--•----------------------------------------------- <br /> # ------------------ r: , <br /> t ; <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 -cal Health District. <br /> I ':'. i'w" . / C' .._ ` 5 lv� .wn r and or Contractor) <br /> (Signed)--------•-----�,�---�--f----------- --- --- - - �- ---- � .. * � <br /> � " 5 a--L�. a y Title 1� l ------------ <br /> +. <br /> •----------- � .---Y,-= ----- _ I ,F°:----------- <br /> By: <br /> (Plot plan, showing(size of lot, locati n of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> 1 FOR DEPARTMENT USE ONLY <br /> - t Y - <br /> APPLICATION ACCEPTED 8Y- --- --------------- I DATE r / - ----------------------------- <br /> REVIEWEDBY--------------------------------- -------------:------------- -- --------- DATE----------------------------------------------------------- <br /> BUILDING PERMIT ISSUED----------Ii ------- ----- --_._ ------- - - --- <br /> V- - DATE--------------- <br /> --�---- ------------- <br /> _ - <br /> i .. <br /> aton ` nd/or`r -- - -------E••-----Alteri <br /> - ------ -------------------------- <br /> F == -----------------------•- -- <br /> FINAL INSPECTION BY:------ <br /> A��----------rJ <br /> = Date... -�----`-s-------- - --------------------------- <br /> ,. SAUIN LOCALHEALTH DISTRICT <br /> 1501 E.Ha:etton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> F.P.co. <br /> k <br />