Laserfiche WebLink
FOR OFFICE USE: , <br /> - p APPLICATION FOR SANITATION PERMIT Permit No. ��f--� <br /> ------------ ------------- - (Complete--in Duplicate) Date Issued - ---/ 1�`�J <br /> --------- This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health Distr' t for a permit to construct and install the work herein described. <br /> This application;is made in compliance with County Ordinance - <br /> JOB ADDRESS AND LO TION___ r ----------------- <br /> Owner's Name-------- 1Z.G �=----------------= _ Phone <br /> Address-----------•---•-------•-•-----� 1 - ---- - --••-------- ---------------------- ----•-•-------- -CEJ...----• T/ <br /> Contractor's Name--.-- ~ <br /> i Phone-_A4 ._�-r�- <br /> Installation will serve: Residence ❑/Apartment House[ Commercial ❑ Trailer Court ❑ Motel EJ Other ❑ <br /> t __ __ <br /> Number of living units: <br /> /_ Nu ber of bedrooms _ _-_ Number of baths__-f-- tot size,::_ -__.0------- -------��'�--- ---------- <br /> Communit El system Private Depth to Water'Teible <br /> Water Supplyc' Public system ft <br /> Character of soil to.a depth of 3 feet- Sand [I Gravel ❑ Sandy Loam E] Clay Loam ❑ Clay ❑ Adoberdpan ❑ <br /> Previous Application Made: (If yes date_.................. ) No C1 New Construction: Yes ❑ No `FHA/VA: Yes El No [I <br /> , 2 <br /> ' TYPE OF INSTALLATION AND SPECIFICATIONS: ` <br /> o septic tank or cesspool permitted if public sewer is available within 244 feet.) r �l <br /> Se Ta Dist ance from nearest well-----------------Distance from f•oundation__----.-----_._,_... Material --._-______.__._.___.__-_.________..._.___.__-. \ <br /> Size_ =: --- -------Capacity----- --------`---- <br /> � _ T - � �- - f^' � --;-::-----Liquid�d depth---- ---- - ---- <br /> No. of.compartments_ _�•___-_._�__ q <br /> 'f nd <br /> om <br /> Dis os Field: Distance from,'nearesjt well.. �n��enarice th ofreach line-- t,�Q--/� ` Distance to nearest lot line_-. --f..__ <br /> s <br /> Width of trench_.�.u!!- <br /> Number of lines. 9yf -------- <br /> X, <br /> gi <br /> f a " <br /> ' '. Type of ilt& nna_t,na Depth of filter material-- _�f�_.._._.-_Total_t length___.' +�F�-------- <br /> Seepage Pit: Distance to nearest well.....:... .. .. -Distance from foundation________._._______-.Distance to nearest lot line---------- <br /> ❑ Number of pits--------)............Lining material-------- --------- Size: Diameter------=-----------=----Depth----------------------------: - <br /> --- <br /> I Cesspool: �} istance from 'nearesst well ---__----_"__.__Distance from foundation_... - Lining material-.---------------------------------- a <br /> S ze: Diameter.l-- ----�--- ----- ----- -----Depth..............................---- --- . ---"------Liquid Capacity----------------------------gaIs. <br /> l F-1 .I -�.°-- v— - <br /> Privy: Distance from nearest wel!..............__...___......-..._._ .... E}istance fro nearest budding-.- <br /> ❑ " <br /> Distance to nearest lot line ---- — - ------- --------------- <br /> jr <br /> - �. <br /> -,. r <br /> Remodeling and/or 'repairing (describe}:�_:_a-.--- ------- -- ------n-------------•-- ---• -------------- <br /> ---------------- <br /> -------------------------------­­�----------- ---------- --- '--.--------- <br /> - ---- ------------------------------------------------------------------------ ---.-- <br /> x ---------------------------- '" „-..-- -------------------- ------------------------------------------ <br /> ------------------•------- ---- ---- --------- <br /> ------------------- -----------------------_ <br /> ------ ----- <br /> ! hereby certify-that I have prepared this application and f atfhe work will be done in accordance with San Joaquin County <br /> ordinances,�4_t <br /> and rules and reg tions of the San oaquin LocalrHealth District. <br /> E: <br /> (Signed) . -- -- - ------ `n r� d�°rContractor) <br /> , ------ <br /> (Plot plan, showing size of lot, Iota+ion of Sys+em in relation to IIs, build��i., can be placed on reverse side}. <br /> FOR DEPARTMENT-USE 6NLY- •- -- -- <br /> APPLICATION ACCEPTED BY 1` - ------------------- DATE------ - <br /> -- - <br /> REVIEWEDBY------------------------ ----- --- ------------------------ -----------------_- DATE =: <br /> BUILDING PERMIT ISSUED-------- ---------- ------------ - --------------------- DATE <br /> s <br /> fAlterations and/or recommendations---------------A------- ---------------- ------ -------------=--------------------------------------------------i------------------------------- --------- <br /> 1 `- -----•---------- ---------------------------------------------------=------------ <br /> ------------------------ ------------------------------------------ ----------- --- <br /> I -----I------`-----'------- ------- <br /> ---- - <br /> -------- •-- <br /> ------ --------- --------------- ------------------ <br /> ---- <br /> r --------------- ................... --------------- -------- ----------------- <br /> - <br /> �j-� l9 <br /> FINAL INSPECTION [3Y: ----------- ------------ <br /> Date—_ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 4` 300 West Oak Street 124 Sycamore Street 20.5 West 9th Street <br /> Stockton,California t Lodi. California Manteca,California Tracy,California <br /> E.K.9 2M 1-67 Vanguard Press ' <br />