Laserfiche WebLink
FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT Permit No. _ ,� <br /> --- {Complete in Duplicate} Date Issued 2 <br /> _ I <br /> Application is hereby made' the San Joaquin Local-Health District 'Fr_orrl Date issued <br /> ---�---- ---- ---- ------ -- --------- f• -.�-.- -- This Permit Expires 7 Year <br /> pp y q for a permit to construct and install the work herein described. <br /> This application is made.in compliance with.Counfy Ordinance N 549. AJ <br /> S A ��; SQ- c2 '- / i i -�? Z ZTe_x906,. <br /> .306 ADDRESS AN LOC�,TION. - _____. _ __ __________ _- <br /> Owner's Name •/�► #`i ` --- <br /> qq � / <br /> Address..................... � .......... -0- -- G�,*/-�^/--------------------------- <br /> Contractor's Name = --- .. --------- ------ 0-. .�_ --------------- - ------------ Phone.AX4(efke <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> q <br /> Number of living units: j--- Number of bedrooms ---Number of baths -1._:_ Lot size _47_0__efle - ---------------------- <br /> l Water Supply: Public system ❑ Community system ❑ PrivateX Depth to Water Table 7Q'ft- <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> Previous Application Made:IND <br /> {If yes,date__--_-____,.-____-) . No New Construction: Yes ❑ No�.--`FNA/VA: Yes E] No <br /> TYPE OF INSTALLATION SPECIFICATIONS: ' <br /> (No septic tank or cespool permitted if public sewer is available within 200 feet.) r <br /> .1, 1­6 <br />' Septic Tank: Distance"from nearest well------------ from foundation-- ____' <br /> _ ---- <br /> ------Material------------------------------------------------- <br />�, ❑�jC[.�i �� No. of Blom artments------ ------------__-__size---------------------_ __Liquid depth----------------- ---- Capacity.-, <br /> I �/ <br /> Disposal Field: Distances,from nearest weli__1_lQ -._Distance from foundation-_ .-_____.Distance to nearest lot line--1-:5e _ w <br /> Number of lines._ - _:_.___Length of each line____? _____--_ r Width of frenclr__��_____________ _____ <br /> Type of:filter material __ __Depth of filter material------r__9._:y.-1_Total length-_---. - _ <br /> 4 n <br /> i ^ r � -Y <br /> Seepage Pit: Distance.,to nearest well__ __. ._la.-._-----Distance om f ndation_ �_______.Distance to nearest lot line_ <br /> ----. C� <br /> 11 <br /> Numberof its- I. _-Lining material- Size: Diameter__- <br /> _- I P '� g - -Depth . " <br /> Cesspool: Distance from nearest well__________ _____Distance from foundation___ --_____ ____._.Lining matrial-__,__------____-__--___--_._________ <br /> ❑ Size: Diameter_________________---------------------Depth ---------------------------------------------------Li uid Ca Capacity -------______gals. <br /> Privy: Distance from nearest well__________________ ______________________________Distance from:nearest building___--.----_________--_-______--__-__---_. <br /> fl Distance to nearest lot line <br /> Remodeling and/or repairing (clescribe):__ __ _ f1I - <br /> c"'[. 1. [rSof' y .. - - ---- ------------------------------------•---------------• <br /> Ili <br /> IM. -. <br /> ----------------------------------------------------------------- <br /> ------------------------------------ ----------------------------------•-----------------------------------------------------------------------------------------------•----------------------------------------- <br /> I hereby certifythat I shave prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, Stafe I rs, and 'ru s and regulations of the San Joaquin Local Health District. <br /> h' <br /> (Signed} - /' - Q --------- - --------- {Owner and/or Confracior) <br /> By: ------ `�- F�Q fit 4 (Title) �-------------- --- - - ---- --- 5 <br /> (Plot plan, showing size of lot, 6ca�system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED!'BY-------�- 4c' ---- /2 /� <br /> ----- DATE----- -----•----1--.�-�.. ------- ------------------ <br /> REVIEWED6Y--------------------- 'I--------- --------- -------------------- - ------------------------------------------- DATE-------------- --------------------------------------- <br /> BUILDING <br /> --------- ---------------------------BUILDING PERMIT ISSUEDA-- r--------- DATE-------------------------- <br /> Alterations and/or re co mendations---------------------------------------------------------`-------------------------R-----------•------------------------------------------- ---------------- <br /> �z-d---`---------- p -- ---------- - _ <br /> ----- ---- ------- <br /> - ------------------------•--- <br /> �... - ----------- --- ----------- --------------------------------------------------------•- ----------------- <br /> .I! <br /> ---------------- ---- -------- --------------- <br /> ---------- :----------------------------•------------------------------------------------------------- ------------------- -------------- ---------------------------------------- <br /> ! <br /> FINAL INSPECTION BY:.:I �-------------------------------------- Date..... 6 <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT ' <br /> l 1601 E.Hazellon Ave. ' 300 West Oak Street 124 Sycamore Street 1205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> I F..P.c o. <br /> 1< <br /> �I <br />