Laserfiche WebLink
FOR OFFICE USE: <br /> -------------------------•--------------- ------ / <br /> APPLICATION FOR SANITATION PERMIT Permit No. ...�4. '.a � <br /> V` (Complete•in Duplicate) <br /> -- ------ --------- ------------- - - <br /> Date Issued <br /> -------- ------- ----- --------------- ---------------- This Permit Expires 1 Year From 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 co fiance with County Ordinance No. 549. <br /> JOBADDRESSADDRESS AND O ATIO ------- ----- <br /> Owner's Name-------------- ---- R09�-D------ ------ ----rcR0� _N <br /> AL44 Phone------------------------------------ <br /> Address------------------------- �.......A_4- -M__ 1n---....AV i�............ ................... ............................................... <br /> Contractor's Name---QWqJE:.A---------------------------•--------------------------------------- ----------------_----•--- _ ---------------- Phone................................... <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [3 <br /> Number of living units: A-_-_ Number of bedrooms .ZNumber of baths-1--- Lot size ___A­_�-91=_fl_G --.------------------------ <br /> Water Supply: Public system ❑ Community system -C] Private Er"6epth to Water Table -10 ft <br /> Character of soil to a depth of 3 feet- Sand @3- Gravel.0 Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date------------ t W6,f2./Nlew Constructions Yes ❑ No &- F A/VA: Yes ❑ No <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 /> EXtf3Tr/ [G No. of compartments-------------------------Size------------------- -----------Liquid depth--------- ------- ---- -- Capacity------ ---------------- `` '' <br /> Disposal Field: Distance from nearest well---�------Distance from foundation-__ Q..----_---.Distance to nearest lot line-_5.. N <br /> EXtQr11f6Number of lines------------/.._.-------- -------Length of each line__ ---- Width of trench____Z __1 ` <br /> ---------- <br /> Ro �) <br /> Type of filter.material.___©_�-K-_._Depth of filter material___-.�_.�_--__---._-Total length--- <br /> Seepage Pit: Distance to nearest well-_------------------Distance from foundation-___-__--_-.--__-.Distance to nearest lot line_--_--_-_-.-----. <br /> ❑ Number of pits---------------------Lining material-------- ------------. Size: Diameter.----------------------Dept h--------------_---_------._-_--_ <br /> Cesspool: Distance from nearest well ----------------Distance from foundation--------_------ -.Lining material--.-.-._---------------------------- <br /> 171 Size: Diameter- ------------- ------ ---------Depth---m----------- ---------- Liquid..Capacity-------------- ------------.gals. <br /> Privy: Distance from nearest well------------ --------1Y----------------------Distance from nearest building.,_'.__.--___-----._-__-------_-_------ <br /> ❑ Distance to nearest lot line ------------------------- ------------------------------------ ------------------------------------------------------------------- <br /> Remodeling and/or repairing (describe)=---- ------------ -------------- ---------------------------------------------------------------=--=-------------------------------------------------- <br /> ----------------------------------=----------------------- --------------------- ------------------------------------------------------------------------------------------------ ---------------------------------- ------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> -------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- --------- <br /> I <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 w a res and regulations of the San Joaquin Local Health District. <br /> (Signed)------ = - --------1 ----•-- - -------(Owner AELZracer) <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------77—i-_n--0------------------------- ------------------------------------- DATE-------3_ 2� 7 <br /> REVIEWEDBY------------------------------------ --- -------- --------- --------------------- --------------------------- --------- DATE------------- ---------------- ------------------------- <br /> BUILDING PERMIT ISSUED--------- ---------------------------------------------------------------------------------------- DATE----- ----------------- <br /> Alterations and/or recommendations:----------------- ----- -- - ---------------- ------------------------------------------------------------------------11-1-1-------------------- <br /> ---------- -------------------- -------- -- ------------------------------------------ ----------•-------=---------------------- --------- --------------------------------- <br /> ........... .............. ....------------------ ------------ - -- --- ----------- ------------------- <br /> FINAL INSPEC - -��--- ------ ---- ---- — Date <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 20S West 9th Street <br /> Stockton,California Lodi California Manteca,California Tracy,California <br /> E.H.9 2M 1.67 Vanguard Press <br />