Laserfiche WebLink
FOR OFFICE USE; <br /> ------- - - <br /> - --- ----- ----- --- ------ n . . <br /> ------------- SAP LICATIO SANITATION PERMIT Permit No. _. y <br /> -------------------- ----- --------------------- (Complete-in Duplicate) �� 3/. <br /> --- -.--.-------- ----- -----------.---.-_--.---------. This Permit Expires 1 Year From Date Issued <br /> 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 LO ATION Jg11 . w-------------------------------------- '----.-- <br /> Owner's Name----------- ----_- U-6.05 ......... 5k!" N/'7---'----- - - ---- -------------------- ------ -- ----- -------- Phone.................................... <br /> Address----------------------1u5!2.....tv......M�1 N - MT . <br /> Contractor's Name--QW.&W-A--------------------------- *-� Phone .._. <br /> Installation will serve: ResidenceApartment House [ ] Commercial E] Trailer Court ( Motel C] Other ❑ <br /> Number of living units: .r�. —_ Number of bedrooms Number of baths Z-- Lot size _ .Qy _. f -t- <br /> Y.� . <br /> Water Supply: Public system ❑ Community system E] Private to Water Tabfe _ ft <br /> Character of soil to a depth of 3 feet- Sand E] . Gravel 0 Sandy Loam Clay Loam E] Clay E] Adobe E] Hardpan ❑ <br /> Previous Application Made: (If yes,date--------------- <br /> Ndlew Construction: Yes o 0FHA/VA: Yes ElNo � <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is availbble within 200 feet.) <br /> Septic Distance from nearest well.-_? _Distance from foundation_10----------.Material '/1fGRil` T" --------. \) <br /> No. of compartments _-2._.._-_. ._.Size._ __ . 1-_x ►'_-_Liquid depth_:1 j .-Capacity../eleQ - <br /> Disposal Field: Distance from nearest well----- _Distance fr'o' m l 0.___-____. <br /> p � `om foundation_._ is#ante to nearest lot line..... <br /> Number of lines_.__-_- � ---__.. __-._Length of`lath line,, __�Q__._`.-_ Width of trench--------2�C!_ .__.-__-_--- <br /> r__._. <br /> Type of filter material-__-ROCK _-Depth of filter material_ 1 - Total length__--_--4- - - ------------------ <br /> Seepage Pit: Distance to nearest well __.---------------Distance from foundation....................DLtance to nearest lot line----------------- <br /> El Number of pits---------------------Lining material-------------.-------- Size: Diameter----------._._.-------Depth-----------------•------.__------ <br /> Cesspool: Distance from nearest well ____-_ ------Distance from foundation------------- _:Lining material..____________________..___-_---_ <br /> ❑ Size: Diameter- ------------ ---------------Depth------------_ -------------------- ------Liquid Capacity-------•-------------_----gals <br /> Privy: Distance from nearest well____.__:-______________.____._..............Distance frofn nearest building__.__-__--____.____-_-__-_-_____-._____.. <br /> ❑ Distance to nearest lot line--------------------------------------------•---------------------- - <br /> Remodeling and/or repairing (describe):------- ----------------------------- --------------•-----------------------•------------ ------------------------------------------------• <br /> t <br /> ----•-------•------•--•---------------------------.---•--------------• ---------------------------•-------•----------------- ---•----- -----•-------------------------------- <br /> ----------------•••----------------------------•----------------------------------------------•---•---- -----------•-----------:---------------•---•-------------------------------------•--------•------•------------ <br /> - -----------•--------------•----------------------------------------------------------------------- <br /> 1 hereby certify that I have prepared this application and that the work will be done.in-accordance with. San Joaquin County�Ii <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> - ;i <br /> (Signed)-------------- ------------- -------- ------------- ---- - ---•'---- ------------------------ --------�-- ------•-------------------- ,-._,-Owner and/or Contractor) <br /> By:------------ ----------------- -- ------ ----- ---- ------ -- ---- -----------------(Title)---- - ---- ---... -------- ------- <br /> (Plot plan, showing size of 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-------" r{ R• ------------------------------------- ------------------ DATE-------- <br /> REVIEWEDBY-------------------- ---------- --------------------- ------------ ------------------------------------ -------- DATE <br /> BUILDINGPERMIT ISSUED---------- -------------------------------------- --------------------------------------------------- DATE <br /> Alterations and/or recommendations----------------- ----- - ------------------------ ------•---- -------•--------.--•----••----------------------------------••----------- <br /> ------- ------------------------------- ----- ----------­--- ------------7 -•- --- ------ ---- ---- <br /> FINAL INSPEC - DateG` <br /> ----------- ........... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi California Manteca,California Tracy,California <br /> E.H.9 2M 1-67 Vanguard Press ar <br />