Laserfiche WebLink
FOR OFFICE USE: ` (� <br /> '� Permit No. .Co. '._.d�,35� <br /> ______..___._-.__.-__.---------fkL.3._`r� APPLICATION FOR SANITATION PERMIT <br /> ------ -------------------------------------- --------- (Complete-in Duplicate) <br /> --- --------- ..__ -__-_-----. ------ ---------------- 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. <br /> This application is made in compliance withCountyOrdinance No.549. <br /> JOB ADDRESS AND CATION ?`_fC--. �------------- ------------------------------------------------------------- <br /> Owner's Name----- -- - , ---------- <br /> -------- ----------------------------------------- Phone.................................... <br /> Address �/ � .. _ 1._ <br /> _ <br /> Contractor's Name------ ---------------------------- -------•----'-----------------•-•----•----•--- Phone----------------------------------- <br /> Installation will serve: Residence �partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of livingunits: __ _ Number of bedrooms <br /> .,7--____ -_ Number of baths __ Lot size __49Q__ ---`_ _s ____________________ <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table,95�47 ft <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe &I ardpan ❑ <br /> Previous Application Made: (If yes,date------------------ No R,?'New Construction: Yes ❑ No in---FHA/VA: Yes ❑ No g; - <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_________________Distance from foundation------------------..Material ------------------------------------------------ <br /> Al�'No. of compartments------.-------------------Size---------------- --- -----------Liquid depth--------- . ----- ------- Capacity--_ <br /> Disposal Fiel Distance from nearest well------- ______Distance from foundation..'ld_______-Distance to nearest to line_ __.._.. <br /> Number of lines.____._/_`_-___f...._._.-.-,,-Length of each line__._ �l_.___.�___.Width of trench_. -_. ----------------- <br /> Type <br /> ______-____..__ <br /> Type of filter material- Depth of filter material._/` ----.Total length r''r------------------------ -- <br /> Seepa a Pit: Distance to nearest well_____._----____Distan rom u tion_lZa.*___.Distance to nearest lot lin�e__la�.�_.. <br /> ( jO Number of pits__Z-.__.-____-Lining materi ize: Diameter-_�'�_�_$___Depth_Xe__ ____________________ <br /> Cesspool: / Distance from nearest well ________________Dista ou ------- <br /> ..Lining material-----..---------.________-_--___-_-__. <br /> ❑ Size: Diameter- -- ------ ------- --- -----------Depth------- ----------- ---------------Liquid Capacity--------- -----------------gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-__-_--________________________-_.-. <br /> ❑ Distance to nearest lot line------------- <br /> Remodeling <br /> ----------Remodeling and/or repairing (describe) . <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 <br /> the San Joaquin Local Health District. <br /> (Signed)---------------------- -- �l 6 -------------------- ----- -- --------- -------------- -------(Owa+M"e+�r_Contractor) <br /> By:------------------------------------------------ ------- --------- -- - --- -'-----------(Title) �i� "'------ --- ------ -------- <br /> (Plot plan, showing size of lot, location of system i ation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------------- -- ---------- -------------- ----- DATE-------J.?v_A, <br /> REVIEWEDBY--------------------------------------------- - -------------- ------ DATE----------------------- ------------- <br /> BUILDING PERMIT ISSUED---------- ------ DATE--------------------------------- <br /> Alteratio sand/ reco en tions___________ _. <br /> _7 2 �� - --- <br /> -------- ------ <br /> -----------------I--------- --------­­­--------- ---------------------------I------- ------- ---------------------------------------------------------- <br /> __----- ---- I-------------------------- <br /> -------------------------- -----­­.......I-------- ----------------I----------------I----------_----------1------------- ------------------- ------------ ------------------------­ ------------------------------ <br /> 1111 <br /> FINAL INSPECTION BY:..........e, hr---------------------------------------- Date------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Strott 205 West 9th Street <br /> Stockton,California Lodi California Manteca,California <br /> Tracy,California <br /> E.H.9 2M 1.67 Vanguard Press <br />