Laserfiche WebLink
F R OFFI E SE: <br /> '' � APPLICATIONtRf y <br /> .... ----------- - - - ------ -� <br /> 11 <br /> -------------------- ----b r -SANITATION PERMIT Permit No. <br /> -------------------------------------- (Complete in'Duplicate) <br /> ----------- -- -------------- ------- - - <br /> - ----------- This Permit Expires 'I Year From-Date Issued Date Issued ____1.1.11....;. <br /> --- 111.1.. <br /> Application is hereby made to the Sen 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 LOC Ti ------ ------ ----------- ............................................................ <br /> .....--------•- <br /> 49 <br /> Owner's Name ...... ----- Phone1 <br /> AdJress ` f1f <br /> = -------• ------------- ............................ -•--•-•--•. <br /> ....... w <br /> 1111.----•-----••-•--•• -- <br />� r ,t ^ + <br /> Contractor's Name............... ........ `.. .......== ..-.._hone................... <br /> Installation will serve: Residence Apartment H use O 'Cmmercial ❑ Trailer Court Motel ❑ Other ❑ <br /> ., t s , <br /> Number of living units: ____1 Number of bedrooms .--; -_ Number of baths Z... Lot size -------- 3_. ..........,l_j?:n__ ___________ <br /> r s k <br /> Water Supply: Public system ❑ Community system C] Private ) Depth to Water Table 3_J_ ft. <br /> Character of soil to a depth of 3 feet: Sandi❑ Gravel ❑ Sandy Loam& Clay Loam] Clay ❑ Aclobojo Hardpan ❑ <br /> Previous Application Made: (If yes,date------ ------------) No IV New Construction: Yesk No ❑ FHA/VA: Yes ❑ NojM <br /> TYPE OF INSTALLATION AND SPLIFICATIONS: <br /> (No septic tank or cesspool permitted.if public sewer is available within 200 feet.) <br />' Septic Tank- 9 Distance from nearest well_________________Distance from foundation....................Material................................................. <br /> No..of com artments------------------ -Size-----.-_------.------4.�-.-•-Li uid de th---.---.--------- -- Ca aci <br /> yty <br /> s a' ", > <br /> If <br /> Disposal field: Distance from nearest well_____" ____Distance fro6 oundation_______La_.-___.Distance to nearest lot line__-__6.-__..... <br /> y l� Number of lines_4____________�______ L'e��ngth of each line______F'3_4'_ ........Width of trench............ Of+_1111_.__..____ <br /> Type of filter material•_._ _ __ ___Dopth.of filter material_____ /`________Total length._.__.__.__?----•___ <br /> ------ <br /> Seepage Pit: Distance to nearest well------ _._.Distance fro -fou dation_.._.-/"_-___.Distance to nearest lot line.... .......... Ct� <br /> Number of pits___=___- ____________Lining material..... Size Diameter___, _A Z_--_...Dep th___---.._ l......... <br /> Cesspool: Distance from nearest well_____�,_____.._DistanceRfrorn foundation-------------------_Lining material______......___._.................... <br /> Size: Diameter---:---------------------�----------Depthl------------------------------------------------Liquid Capacity............................gals. <br />' Privy: Distance from nearest well---- ................ ..-.-----------._Distance from nearest building_-____._____________-___-.---_.-_ 'n <br /> ❑ Distance to nearest lot line- -----------------------------------------------.............-------------------------------------------------------- <br /> Remodeling and/or repairing (descr be):-----••-----_----- ---_...-----•------------------•-• •-•----•--------------•----------------------------•--------------------------- <br /> i I r me <br /> r <br /> -------------------------------•---•--------•-••--•----------------------------- -- <br /> ---------------------------------------- --------------------------- <br /> -----------------------•-----------------=------------._.._.--------------- »..._.._....._...-----------------------------------------------....-----------------------------••-----••---•----••------------- r- <br /> Ihereby certify that I have prepared this application and�that the work will be done in accordance with San Joaquin County <br /> ordinances, State law and rLj s and rgVations ofj+he San Joaquin Local Health is ict. <br /> • �� <br /> {Signe' - � r nor and/or Contractor) <br /> - .. ...-----•---•-it.............•----• --•- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> ,) DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----- -- -------- ---------------------------------- DATE------✓-� ,3 --� Z---------••---------- <br /> REVIEWEDBY ------------ ----------------------------------------------------------- DATE.----------------------------------:------------111.1------- <br /> BUILDING PERMIT ISSUED----------- ------------------------•--------------.._-------------------------------------- DATE-----------------------------------------------•------•----•- <br />' Alteration and or recommendations: ----------- -----------------------------•------------------------ <br /> --••---------- <br /> ,� a'- f----- -- --------r'.-``----------•-- <br /> - ------- -------- - -- -- - .- -- ------...---1111 . <br /> .......---.....-------------.....................-•-----------­---- -------------------••-•--•----•-------------------- -------------- ---------........................................................ <br /> i <br /> .:...................•--------------....------•-------------•-•-----•----------------------------- -- <br /> -: ------------------------------------...---------------------------------...---•------------------...-.-------------- <br /> n •� u <br /> ---•-••----•-------•---•---•---------------------------------------- <br /> - <br /> FINAL INSPECTION BY:.-----� = -- ---- Date-------- 11/ �r <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT • <br /> 1:30ti o th American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Stmt <br /> Stockton,tallfernia Lodi',California s Manteca,California Tracy,California <br /> E!3 0 REVISED 8.59 2M 0-61 A1LA9 • ,w�-_� -_ <br />