Laserfiche WebLink
I'UROFFICE USE: <br /> --------------•------- ----------------- --------- <br /> --------- ------------------- -------------------------- .,APPLICATION -FOR SANITA ON PERMIT Permit No. .i J. <br /> J <br /> -------------------- ---- --------------------- -- (Complete in Duplicate) ff y <br /> - ----------- -- - --- This Permit Ex ires 1 Year-From Date Issued: Date Issued <br /> Application is hereby made to the'San Joaquin Local Healfh District for _ <br /> q permit to construct and install the work herein described. <br /> This application is made in compliance with Count-Ordinance No. 549, x 2=b _r"Spr/3 <br /> JOB ADDRESS AND • OCATJON �---- `, 111217T, <br /> /� a� <br /> 7 , _.. = 1 1 L- 2- ----- tc _i ---------- ! <br /> �C i D _ y } <br /> Owner's Name....... = - C .. ---------- PhoneIfAlf-----------------`-- F <br /> Address =---- ------- ------ ----- I <br /> Contractor's Name------- --- Phone----------------------------------- <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ®�iL2J �L <br /> Number of living units: -------- Number of bedrooms --- Number of baths __/_. Lot size _--t►�- n . '-: �T_F i.----______---- <br /> Water Supply: Public system ❑ Community system ❑ Private [}Depth to Water Table -�+?�ft. <br /> Character of soil to a depth of 3 feet: Sand ® Gravel ❑ Sandy Loam ❑ -Clay-Loam ❑ Clay-CI Adobe ❑ Hardpan <br /> Previous Application Made: (If yes,date......... ...... } No New Construction: Yes I <br /> �..� � , . � -- - - �� � [T�'-No�❑ FHA/VA: Yes ❑ No ®� , <br /> TYPE OF INSTALLATION AND -SPECIFICATIONS- <br /> (No septic tank or cesspool permitted if public server is available within 200 feet.) <br /> Septic Tank: Distance from nearest ---- <br /> Distance from undation__-I_ -..--Mater Li+ 2i�_[ <br /> ®� No, of compartments------�---_..-....-_Size C _-.---___Liquid depth---- .-, Cap aci#Y ' _) <br /> Disposal dn.- :__._-.Dis <br /> osal Field: Distance from nearest well__47e---- Distance from:{oundati tance to nearest lot <br /> ♦ 4 a a <br /> ®r Number of lines------------ Length of eaci� line_.., C__.' .... ` Width of trench- <br /> Type of filter material�S-�{x _y ' Depth of f Iter material.__ e ._.. .-..:Total Iongth----....---:, -�--------- <br /> ................. <br /> Seepage Pit: Distance to nearest well 4't-�.______Distance .from'foundation S-__-.._...Distance to nearest lot line_-eWz <br /> Num4aer of its - --------- -;� i <br /> p.'. �,.----- - Lining material-.--_ <br /> Size: Diameter- -'----------' .Depth-� �I4s,.�/��--- <br /> ; . <br /> Cesspool:`:. Distance from nearest Well..... __ -`..._Distance from r'. <br /> ---- materia---.- ------------------------------ <br /> ❑ Size: Diameter--- - .--- --_'Depth---'=----.-`--------------------- Liquid Capaci,tY gals., <br /> Privy: Distance from nearest well.__-------M---------------------- ---------------Distance from nearest'building_-___-._......- <br /> ❑ Distance to nearesf lot line. �- _ - ----------------------------------------------------------------------------------------- <br /> Remodeling <br /> ---------------------Remodeling and/or repairing (describe)-------•---------- ------------- --------------------'----------------- <br /> •-- <br /> --------------------------------------------------- ------------I------------------------------------------------------------------= - •{ <br /> I hereby certify that I have prepared this application and that.the-work'will,be done in accordance with San Joaquin County C <br /> ordinances, State laws,.and rules fa ' regulations of the San Joaquin Local Health District.,(Signed)--- --------- , _ � .z- : ` ( �%.0- f'� { <br /> ------ wn <br /> 8Y = -------1 -,�= y-'----- (Tit)e)------------------- ----------------------- -- - ---- <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. ��.r7�2'P�'�J DATE---,,�;R-~-_6 -4 7 <br /> REVIEWEDBY---- ------------------------- ----------- ------------ ---------- -------------------------------------------------------- DATE <br /> ----------:- <br /> BUILDING PERMIT ISSUED -----�'✓------------------------------------------------------- DATE--1e.� a '1 J <br /> Alterations and/or recommend'• tons:_...*--------------- - ::-:! <br /> --------------- --------------------- ----------------------------- -----------------•--------------------------------- --------------------- -----------------------------------------------­----------•--------• l <br /> - <br /> ------------------------------------------ <br /> --------------------------- ----- <br /> FINAL INSPECTION Date.------z--'--Ts- -- - -- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1401 E.Haielton Ave. 300 West Oak Street 124 Sycamore Street 205 west 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> M <br />