Laserfiche WebLink
FOR OFFICE USE: _ <br /> ,3 -- /f F �� <br /> Permit No. <br />- ------- -------- - -------_-----------_-----.--- -, APPLICATION FOR SANITATION PERMIT �_---- ---•••- <br /> (Complete in Duplicate) 3 � 3 <br /> Date Issued - <br /> --------------------------------------_..__----------. This Permit Expires 1 Year From 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 549. <br /> r � - <br /> JOB ADDRESS AND LOCATION.......... -------- --- `" -----• -------------••------ --- <br /> Owner's Name__.. C _:.4`j lc_ ---------- ---- Phone <br /> Address-_ / �•.. �,� -u �•, = 4 Y <br /> Contractor's Name--___�-• `c) �"t °�` -- ------•-••• Phone--- ------- --- -- -- t <br /> _ ----------------- <br /> Installation will serve: Residence ®/Kpartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ___/--- Number of bedrooms -_/-. Number of baths __ -- Lot size --------------------------------------------------------- <br /> Water Supply: Public system 9-l"Community system ❑ Private ❑ Depth To Water Table -------- ft. }� <br /> Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam [3Clay Loam ❑ Clay ❑ 'dobe Hardpan ❑ <br /> Previous Application Made: (If yes,dote-------------____.I No ❑ New Construction: Yes C] No 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 /> Sc Ta 'Distance from nearest well-----------------Distance from foundation____-----___._...._-Material._____._-________-..._.____---_.-________--____. <br /> No. of compartments--------------------------Size--------•-••--------------.-:_Liquid depth ------------- ----------Capacity--- ---••-•----------- <br /> posaj Distance from nearest well_M_`..____....Distance from foundation .�*J____/.Distance to neares��e�_�___r/ <br /> i <br /> f Number of lines__---_I_________________ _ Length of each line_ --___ -- ------Width of trench---_..______.. --�_._._____.... <br /> 1 De th of filter material.--__-� ---...__Total length---..------��.---------•-------•- rn <br /> .� G Type of filter material-`-____�..-- p - V\ . <br />, Seepage Pit: Distance to nearest well__________________ <br /> _-_Distance from foundation....................Distance to nearest lot line._.____--__-___.- <br /> i ❑ Number of pits----------------------Lining material-----------------------Size: Diameter -----Depth--------- •------------ <br /> I <br /> Cesspool: Distance from nearest well-----._______--_Distance from foundation--------------------Lining material-...________._______-_-____..____:__ O <br /> ❑ Size: Diameter------------------------•-------------Depth--------------------------• ---Liquid Capacity----------_------------...gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building.______________---_______•_--.._________- <br /> ❑ Distance to nearest lot line----------------------------------------- -----•------------ ---------•----------------------------------------- ------ <br /> Remodeling and/or repairing (describe: ---•--------•--------------------------------------- <br /> •--•---•---•---•------.-------------------••-.. <br /> ------------------------------------- <br /> - <br /> C�--�' <br /> ------------ <br /> - -------------------•---•-----------------------•------------ <br /> - -----•------------------•------------------- <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 I s, and rules and regulateons of the San Joaquin Locq Health District. <br /> SI ned �,� t --------------------------------------------(� Contractor) <br /> - <br /> By:-------------------------- -- - -- -- -------------------------------------•---------- - -- ----------- <br /> 0 <br /> (Title) <br /> (Plot plan, showing size of lot, location of system in relation to Ns, buildings,'etc., can be pieced on reverse side}. <br /> FOR DEPARTMENT USE ONLY <br /> z <br /> APPLICATION ACCEPTED BY----�- -------�-5------------------------------------------------------------- --- 3---------------------- <br /> DATE---�==--•------- <br /> - <br /> ' REVIEWED BY---------------------_- ----------_--- DATE- --------------------------------•----------•--- <br /> BUILDINGPERMIT ISSUED--------------------------------------------------------------___------------------ •-•------------ DATE------------------------------------------------•------------ <br /> Alterations and/or recommendations:-------------- -----------•-------------•------•-•••----•-------..-.-..-..-•--------------------- <br /> I --------------------------•------------------------------------•------------- ------•-------- <br /> r ---•-•------- -------------•-------------------------------------------------------------- ­-------------- -•---------- <br /> FINALINSPECTION BY:-----C------- ----------------- ------------- Date----------- --^---- ---------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street <br /> Stockton,California Lodi,California Manteca,Colifornio Tracy,California <br /> E5 9 REVISED 6-59 2M 5.62 ATLAS , <br />