Laserfiche WebLink
FOR OFLICE USE: <br /> --------- --- -------- ,"-------- ----------- <br />------------------ ------------- <br /> --------------------------_------------- -- ----- ___ --------- APPLICATION FO.h-ANITATION PERMIT Permit No. X1.7_ <br />--------------------------------------------------------- (Complete in Duplicate) <br /> .................. This Permit Expires 3 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. <br /> This application is made in compliance`with County Ordinance No. 549. � } <br /> JOB ADDRESS AND LOCATION----- �. © [ ------ _I'�lF y �Z ---------------------------- SCA�O r�--- <br /> Owner's Name-------- , -RO 6�.�-?------- -�-LL1--S1-1---�--------------�------- ------------ ------ Phone-..-------. .------•---­-------------- <br /> ---------:Z521-- ------- �'� � DC7---------•-F ZQe �---Q-/V <br /> Contractor's Nam e-----OW-N B------I---------------------------------------•----------------------------------•-------- --•-------------------- Phone------••----•-•------------------ <br /> ' r <br /> Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _.. _.: Number of bedrooms J--. Number of baths __2-::--Lo+ size _- CRF --------------------------- <br /> Water Supply: Public system ❑ Community system ❑ Private Depth to ater Table,35- ft, Q <br /> Character of soil to a depth of 3 feet Sand ❑ Gravel ❑ Sandy Loam Clay Loam,.E]/ Clay ❑ Adobe ❑ Hardpan [ <br /> rte• <br /> Previous Application Made: llf yes,date____________________) No New Construction: Yes-0 No 2-- FHA/VA: Yes ❑ No �] l <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br />^+�_ (No-septic--tank-or-cesspool=permi+tedrif�-public-sewer--is-available=wi+hin-200 fee+;l! <br /> Septic Fik: Distance from nearest well-----------------Distance from foundation-------------_-----Material------..---.--------.-.--.--- _.___._...__. M <br /> 93;T7 No. of compartments Size Liquid depth Capacity <br /> Disposal Feld: Distance from nearest well._�Q--_-Distance from foundation.._.__.. Q_._.Distance to nearest lot line--_-__--.�_____ <br /> Number of lines------------------------ -- - Length of each line ` r <br /> -. Width of trench. 2 ----- ----------- <br /> Type of filter materiaL.RO.. -K____Depth of filter materia)-------P7.________Total length--------- <br /> ---- <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation------------------- Distance to to nearest lot line--------------- <br /> [.� Number of pits-----1-1__.________Lining maferiaLjR0-CJ.\......Size:{Diameter.-x_-S/---.Depth-----[2 -.-._------ <br /> Cesspool: Distance from nearest well______-____-.-_Distance from foundation_________..._.___.Lining material-------------------------------------. <br /> Priv Distance Dia <br /> frotmr nearest well-----------------Depth---_:-:---��------------------------_._Distance from n-- Liquid Capacity_...___.___._.________.____gals. <br /> I <br /> Barest building-------------- --------------------------- <br /> ❑ Distance to nearest lot line-------- ---------------------------------------•------------------------------------------------------------------------------------------- <br /> Remodelingand/or repairing {describe}-- - ----------------------------- ---------------------------------------- •--------------------------- ------------------------------------------------- <br /> t <br /> 1 <br /> 1 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) 1-- ' --------------- -------------- ------------------------ --- ----{Owher and/or Contractor) I <br /> 3_ .a <br /> 'gY ­------------ <br /> -------------- <br /> -----------------------------------"" ,." - {Title]. "'.� - <br /> (Plot plan, showing size of lot, locationiof system in relation to wells, buildings, etc., can be placed on reverse side). <br /> t <br /> FOR DEPART,101ENT USE ONLY <br /> APPLICATION ACCEPTED BY---- ----------------------------------------------------------------- <br /> DATE '-r P - <br /> --------- <br /> REVIEWEDBY-------------------------------- ---- - ---r---- ---------------------- --- ------------------ - -•--•-------------------- .DATE-------------------------------------------------- <br /> BUILDING PERMIT ISSUED------------- ------------------------------I------------ ------------------------------------------- DATE-------------------------------------=-------- -------------- <br /> Alterations and/or recommendations: {---------------------------------------------------------------I--•--------------- -------------•---------------=---------I------------------- - <br /> -------------- --------------------------------------------------------------------------------------------- ----------------------------------------`--------------------------------------•-------------------------------- <br /> t <br /> ------------------ ----------------------------- -------_------ ------ -------------------------------------------------------------- --•- -----------------.------------------------------------------- -----... <br /> -----•---- ----------- --------- •---------- <br /> ---- "------------------------------------------------------------------------------- - <br /> ---------------------------------------- --------- -------- ---- -- ----- ----- - ------------- ---------------- --------- ------ ------ ------- - - ------------------------------ <br /> FINAL 1N Date..... <br /> I <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazallon Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street <br /> Stockton,California Lodi, California Manteca,California Tracy, California <br />