Laserfiche WebLink
Metadata
Document management portal powered by Laserfiche WebLink 9 © 1998-2015 Laserfiche. All rights reserved.
FOR OFFICE USE: r' ' <br /> ��- ��.3.°------ --- <br /> -------------------__.__.________...__.____.______--- APPLICATION FOR SANITATION PERMIT Permit No./�'l <br /> ----------------- [Complete in Dupliceta] <br /> ----------"-"-.--- This,Permit'Expires 1 Year From Date Issued "' "` —Date,issued - `---.� <br /> Application is hereby made to the Son 1`Joasuin Local Health District for-a—per—mit-to ' <br /> q construct and install the work herein described. <br /> This application is made incompliance-with County-Ord in-ance'No. 549. <br /> JOS ADDRESS AND ILO ATION_-* -1 <br /> __go 4::�,,� <br /> Owner's Name----- t Phone <br /> 1 ,�s • ----------- ---------------------------------•---:---- -=------- ----•---------------...- <br /> Address <br /> -------------------------------=----------- ;[ i►_ .• . <br /> Contractor's Name _ h n <br /> k -------------- -------------------- ----- --...... <br /> Installation will serve: Residence ❑ Apartment House gaCommercial�❑ Trailer Cour, ❑ MoteII6 Other ❑ '. <br /> Number of livingunits: _ bedrooms ____-- Number,of, baths . __ ii f � ` t <br /> ,_/_ Number of Pedro �_ ,' .- Lot siza �- ���� <br /> ------------------- <br /> Y 1� Communitiy�syste ' <br />{ Water Supply: Publics stem m,❑ Private ❑ Depth to Water Table,&l II <br /> Character of soil to a depth df-3,feef: Sand ❑ Gravel Sand Loa Clay Loam <br /> _❑ Y ❑ y ❑ Clay ❑ Adobe�lardpan ❑ <br /> Previous Application Made: {If yesdate -� s_•� r <br /> f .-- _-�) �No � ew Consfruction: Yes ❑ No FHA/VA: Yes ❑ No [g— <br /> x 4�.+.. <br /> TYPE OF INSTALLATION AND'SPEClPICATIONS: <br /> .(No septic tank or cesspool permittedif--public sewer is available wifhin 200 feet.) l �, <br /> SAtic Tank: <br /> cg�do Not of compartme tsnearest_ --------�- _Dzeance from foundati�q�id depth Material.---- ._Ca Capacity______._ _____--_,--_ <br /> b... p Y ] <br /> f ce f mfoundation____-------Distance to nearest lot line__.~..... <br /> p <br /> Dis osal Field: Distance from nearest we!{ 'Distan <br /> - �� Type of fitter :rnaterial_� '/� "De th of each;hne _*47 n-�....-.-.--Width-cf-trench.A_ <br /> �$ 9 - Number•of. lines_ Length of <br /> - p filter material__-/------------_Tofal length____:�� ---------------r ------------ <br /> Seepage Pit: Distance to nearest well fr fo dation__ ._..-__..Dista��e to nearest lof line e_--_~� \ <br /> ®- Number of pits___________________Lining material___ '�-Size: Diameter__ -_______- <br /> Dept h__ <br /> , i <br /> Cesspool: Distance from nearest well-----------------Distance from foundation__....-----.--------Lining material_-.______.____- c_ -- <br /> ❑ Size: Qiameter • Depth - _:. ----- - <br /> ,. p _-�:...�- - ----_Liquid Capacity --------1W <br /> Privy Distance from nearest well__..___________________________, <br /> ---------------Distance from nearest building------_______------- _-.__-- <br /> ❑ Distance to nearest loft line---------------------- -------- <br /> { s II <br /> ---------------------- <br /> Remodeling <br /> -------- <br /> Remodeling and/or repairing (describe)------------------a ' <br /> y' � <br /> -----I - --------------------------- <br /> ------------ <br /> - _ - ------------- ----------------- <br /> --------------------------- <br /> -------- ----------------- ' -------------- <br /> �.+ . <br /> - -------------------------------------- <br /> ------------ ------------------------------- •---------------------'��'---------------------1--------------------------- ° <br /> I hereby,certify that l,have,prepared this application and that the work will,.be done in accordance with San Joaquin County <br /> ordinances, Stafe laws, and rules°and regulations of fhe San Joaquin Local Health Disfricf. <br /> (Signed] ---lam-- ---- ------- -----------'------ -------- r Contractor <br /> A' <br /> BY 4------•---------------------- ----- --- } il (Title] .. /��- <br /> (Plot plan,,showing size of lot, location of sysfem in ;relaf to wells, buildings, efc.ecan be paced on reverse side). <br /> f FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ----------------------=------------- DATE----------140- <br /> REVIEWEDBY-----------------'----------- I----------- -----------------------•--•------------------------------------- ------------ DATE <br /> 4- _,_,.-. -7- ._ _,�._.., l <br /> BUILDING PERMIT ISSUED----------------------------------------- ----- ----- -------- DATE-- <br /> ----------------------------------------------- <br /> AI#eratians and/or recommendations: - <br /> � <br /> --------------•------------------•--------------• ---•------------- ---------------------- --------------------------------•--------------------------------- ------------ -------------•------------------ <br /> ---------------•- -------------------••------ ----­-.1 ----- <br /> ---------•------------- --------------------------- <br /> ------------------------ -------- --------- ------------------------- - ------------------------------------ <br /> FINAL INSPECTION BY:-.-.____-_---- ,� Date-------- <br /> d <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT _., -•-� �'`-� <br /> _ R <br /> 1601 E.Ha=elton Ave. 300 West Oak-Street t •""'� <br /> A � �124 Sycamore Sf eet 205 West 9th Street <br /> .o Manteca;California <br /> Stockton,California Lodi,California Tracy,California <br /> F.p•C Q. <br />