Laserfiche WebLink
FOR OFFICE US <br /> --- -------- - ----� �� 3 J <br /> - ----- - --- <br /> _.__.__.___.__-____. _� c _-- -__-__- APPLICATION FOR SANITATION PERMIT Permit No. <br /> ---------------- ------ --------------- (Complete in Duplicate) <br /> ________________ This Permit Expires 1 Year From Date Issued Date Issued <br /> Application is hereby made to the San Joaquin Local Healfh 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 LOCATION-------5'9 03 � alb <br /> ------------------------------------ --------•--------------------------------------•-----....._.._...._........-----..............__.--..---- <br /> t. <br /> Owner's Name -- 1----101----------V44:44 --------------------------------------- Phone.......-............................ <br /> -----------10-'------------ = ----- -Address -- _- ----- ----- Phone-A /f <br /> . -- <br /> Contractor's Name---------------------------- --- r <br /> Installation will serve: Residence gr-Apartment House ❑ Commercial E] Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: T-__-- Number of bedrooms -3-- Number of baths __/--_ Lot size ...... f ---___!__. <br /> ----•-------••------- <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table 6 ft. <br /> Character of sail to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan [] <br /> Previous Application Made: {If yes,date--------------------- No ❑ New Construction: Yes ❑ No R'-_F­HA/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 /> p ank: Distance from nearest well------_----------Distance from foundation--------------------Material------------------------------------------------- <br /> No. of compartments--------------------------Size-----••-------------------------Liquid depth------- -------- ---------Capacity <br /> ;spy field: Distance from nearest well JZ41e _Distance from foundation._3_Q--------Distance to nearest lot line---15_.------- <br /> Number <br /> _____Number of lines--------- _______ Length of each line_...._-�0-f------------Width of trench....... ��_-______________ <br /> Type of filter material_-S�_„_�4-_Depth of-filter material_.__ `r__-_-_dotal length---------J_e-__ _________________ <br /> r�s$ Distance to nearest well._ -- -5� <br /> /, '' ��%___Distance f om foundation_ __________.Distance to nearest lot line_________________ i <br /> ®� IN g ,� ----Size: Diameter___ _ ... _ j ” 1 <br /> Number of pits------�----____--_Linin material-- -� -- f•___--Depth------- <br /> Cesspool: Distance:from nearest well----------------- from foundation-------------------Lining material----.__________________--________.___. <br /> ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building___-_-____________,__-__________--_._._ <br /> ❑ Distance to nearest lot line ------------------------------------------------------------------ ---------•-------------------•-----------------•------------------- <br /> Remodelingand/or repairing (describe):--------- -----------------------------------------•--------------------------•--------.......-.---•------------------------------• -----------•------•- O <br /> --------------------------------------------------------------•----------.------------------- -----------------------•---••---------------------------------------- --------------------------------------------------------- <br /> -------- ---------------------------------------------------------•.................-----------------------------------------------------------------------•--------•----------•------------------------------------------- G <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, St a aws, and rules and regulations of the San Joaquin Local Health District. <br /> (Si ned <br /> 9 } ----- ------- - -- /1-- I Owner and/or Contractor) <br /> ----- ------ ---------- ----- <br /> • �-} ^ <br /> Y• J`'r"'` - •----------------------(Tiffs} - --- ---------- ------------ -- -- ------------- <br /> (Plot plan. showing size of lot, location of system in relation to wel0ls, Ildings, etc., can be placed on reverse side}. <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY_ __ -------- ._ y `G CJ <br /> DATE -- - ---------- <br /> REVIEWEDBY-------------------------------- ----- --- -------------------------------------------------------------------•-- --- DATE-----------------------..... <br /> BUILDINGPERMIT ISSUED--------------------------------------------------------•-•--•---------------------------------------- DATE----------------------------- <br /> Alterations and/or recommend'ations:------- -------------------------------------------------------------------------------------------------•-------------------------------- <br /> -------------------------------------------- <br /> "_ <br /> ------ -------•-----••-----------------------•--•--------------•------------------------------------------- <br /> -- --- --- ---- <br /> ------------------------------------------------ ---------- - -----------------------------------------------------•-------.------------------------------------------- <br /> -------------------------------------------------------------------- <br /> FINAL INSPECTION BY-----�.- ---- -------- ----------------- <br /> date-------I::> = r <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES-9 REVISED 8-89 r.P.CD.2M 6.60 <br />