Laserfiche WebLink
Metadata
Document management portal powered by Laserfiche WebLink 9 © 1998-2015 Laserfiche. All rights reserved.
- .FSR.OFFICE USE; o <br /> ------------- --- - ------ I�.--- . <br /> ----- ----- --- ----- ------- ---------------- APPLICATION FOR SANITATION PERMIT Permit No. ._l /�1 <br /> = (Complete in Duplicate) <br /> Date Issued <br /> --- --------------- <br /> (Complete----- <br /> - ---------- <br /> ---- =-- ............. �- �., -.�� p.---�- _ _ - Issued"'' , <br /> This Permlt`Ez Tres 1•Year �From�Date <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 /> I ` <br /> JOB -- p --------------------------------•-------------------------- _ <br /> i <br /> 7�. �`� T�v_�.e�.c1 � <br /> {J <br /> ADDRESS AND,LOCATION______�.4 _--- <br /> U'LOwner's Name-------t/ --------- - - -------------- -------------------- -------------------- ---- Phone------------------------------------ <br /> Address6.dS 5 -------- --- ------ 'c 1-------------------------------------------------------------- ----------------------------------------------- <br /> I <br /> ---------------------•------------------------ <br /> t-- - ---- ------- ----- -------------- Phone-------------------------------Contractor's Name ----------- <br /> Installation <br /> will serve: Residence N_ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> g V - � f-------- <br /> Number of living units: _t_____ Number of bedrooms _ -- Number of baths ____ -__ Lot ___ y <br /> Water Supply: Public system '& Community system ❑ Private ❑ Depth to Water Table _FAQ ft. <br /> Character of soil to a depth of 3 feet: Sand Gravel Sand'"Loam. Cla Loam Cla Adobe' Hardpan <br /> P i ❑ ❑ Y 0-? y❑ Y ❑ Y:❑ �, ❑ <br /> Previous Application Made: (If yes,date- ---___.-,.­__],_No_®, New..Coh`truction: Yes [N No ❑" FHA/VA: Yes k 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__>Lr,_0,X_Distance from fou <br /> A ndation____t_O____'___.M�teri�l_ '1,.[�_Ll!VIA�------------------ <br /> -k <br /> - <br /> p .,. <br /> - - ---------------- <br /> No. of compartments___,-.- __-----------Size_ _I _��Z.�-k�__Liquid depth___�r�__-_-_..___.Capacity-_-_1_�S�_+C__. <br /> Disposal Field: Distance from nearest well 11 b-KA`,Distance from foundation-----!Q _::Distance to nearest lot <br /> ,+F � F <br /> - <br /> r . . ' ------_-----® Number of lines------ <br /> j------- Leng each line O i t- . <br /> Depth material *,---Total lenth__---._----9-0------------------------- <br /> Type of filter mater <br /> Seepage Pit: Distance to nea'estwa _�O Distance fa�ndaton___-_2_�_-- -___.Dstance to nearest lot line__._r______._ <br /> Number ofpits_ ____ ________ :,,--Lining -Size: Dia mete'' <br /> �lNY <br /> ---------------- <br /> Cesspool: DistanDce from E titer nearest well=---------------Di€stance from foundation------------------..Lining material------------------------------------- V1 <br /> -----De th------------------------------ ------._Liquid Capacify-... ----- gals. <br /> ❑ - - - p 9 p Y----------- - - <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building__:_.:____.__---------_____-------------- <br /> ❑ Distance to nearest lot line <br /> Remodeling and/or repairing (describe): Pe <br /> ------- -------------- -- ------------------------------------------------------- ----------------------------------------------------- C 3 <br /> 1 <br /> -------------------------------------------------- - ---------e5=---------------------------- <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. { <br /> (Signed) J --------------------------------------- I----------- -------------- ---------------(Owner and/or Contractor) 1 <br /> By: ---- �—.---.- <br /> (Piot plan, showing size--4 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------�'-_'��-`-- ��--------------- � - <br /> REVIEWEDBY--------------------------------------------- ---- -----------------11----------------------------------------------------- DATE------------------------------ <br /> BUILDING PERMIT ISSUED---__. ------------------------------ --------------------------------------------------------------- DATE----------------------------- <br /> Alterations and/or recommendations------------------------------------------°` = <br /> ------------------------------ --------------------- ---------- ---------------------------------------------------------------------•-------------------------------------------------------------------- <br /> 7 <br /> FINAL INSPECTION BY:....- ........... <br /> SAN JOAQUIN LOCAL HEALTH-DISTRICT <br /> 1601 E.Hazelton Ave. 300 west Oak Street 124 Sycamore Street 205 Weed 9tK Street <br /> Stockton,California Lodi,California Manteca,California a Tracy,California <br /> F.P.CO. - • r f' . <br />