Laserfiche WebLink
FOR QPFICE USE: <br /> ------------------ <br /> APPLICATION SANITATION PERMIT Permit No. .. .... ------ <br /> ..... . -- - <br /> ----------1-------- ------------ --------------- TION FOR <br /> ------------- ----------------- ------------------------ I (Complete in Duplicate) Date Issued Y/Tn-K:�" <br /> ------------ ---------L-------- --- L -This permit Expires 1 Year From Date Issued <br /> ,Application is hereby made to the San Joaquin Local Heali7h;District for a permit to construct and install the work herein described. <br /> T is application is made in compliance with C8u/nfy Ordinanc!e No. 549. <br /> JOBADDRESS AND LOCATION------`- — --------------- --S-3"----------------------------------------------------------------------------------- <br /> Owner's Name <br /> ---------------- <br /> Phone----------------------------------- <br /> ----------- 5_T ! I <br /> Address-------------- - --------- s':-------- ---------L--------Ff---------------------------:------------------------------------------------------------------- <br /> 1�t , ra - <br /> Contractor's Name-.-------..C_)4_4:!__ ---------- ------ ----------------------------------- <br /> Installation will serve: Residence,'[ AparTfmentHouse Commercial El– Trailer Court 0 Motel 0 Other [3 <br /> Number of living units: -------- Nu ber of'�eclrooms 3, _1_`tNumber of bafhs --_;I-- Lot size ------- O_________________________ <br /> Water Supply: Public system Commulnity system El Private El Depth to Water Table -------- ft. <br /> Sand ❑ Gravel [D: Sandy Loam Ej Clay Loam' El Clay ❑ Adobe 19 Hardpan E] <br /> Character of soil to a depth of 3 feet: <br /> Previous Application Made:`(If yes,date--------- -- -----I Nodrn New Construction: Yes No E] rHA/VA: Yes D No,[74 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or CeS5pOOl permitted,if-public'sew&is available w hin 200 feet.) <br /> e 4------------------- <br /> Septic Tank: Distance from nearest w'VI___ttf7f_Ah5tance T�on� foundafion-10----......Material4: - --- ----------- <br /> T depth-----S -1---- ---------Capacity__J_1S"6___-.. <br /> No. of compartments...----- -----------Size:------- -------------Liquid depth --- <br /> Disposal Field: Distance from nearest well.....7777=,Dirston_ce from foundation---go..........Distance to nearest lot line__-_---.-_----__ <br /> Number <br /> ine----------------- <br /> Number of lines___--- Width of trench---- -a --------------------- <br /> --------- ------------------Length of each line <br /> r R 0;Ly --- <br /> Type of filter mafe ial---------------- __De'�fh of filter material------- ... ......Total length------1-4-0--------------- ------------ <br /> C., 7S 1 Z/�_ K <br /> Seepage Pit: Distance to nearest well----------------____.Distance. from foundation-------------*-----Distance to nearest lot line- ------------ <br /> ------Size: Diameter------7!------------Depth--------A,�----------------- <br /> _0 Number of pits--- -----------Lining m <br /> Cess near <br /> spool:, Distance from lest well------------_Distance from foundation-- ------ ....Lining rriaterial.­---- -------------- ------------ <br /> -------gals. <br /> Size: Diameter----------------------------- --------Depth----------------------------------- --------------- Liquid Capacity---------------------- <br /> PrivyDistance from nearest well-------------------------------------------------Distance from nearest building---------------------------:---------- -- <br /> Distanceto nearest lot lin'e...... ----------------- ------------------ ---------------------------------------------- -------------------------------- - <br /> R/modeling and/or repairing (describe):----'-{ ----------------------------------------------------------------------------------------------------------------------------------------- <br /> ----------------------------------------------------------------I-------- -------------------------------------------------------------------------------------------------------------------------------I ---------------- <br /> ------------------------------------- ---------------------------------------I---------­-------------------------------------------------------------------------------- ----------------••---------------------- <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 regulations of the San Joaquin Local Health id. <br /> 0, lrc, <br /> S, <br /> > <br /> T, ..., Owner and/or Contractor} <br /> (Signed)--------------- ------ ---- --------------- ------- - --------__ - L---- C <br /> -------- ----------- ----------------- -- - - ------- ---- <br /> -----------------------(Tit le) <br /> By:-------------------------------------------------- ------ ---------------------------------------------- - <br /> (Plot plan, showingsize of lot. location 6f system in relation to wells, buildings, etc., can be placed on reverse side). <br /> R DEPARTMENT USE ONLY <br /> -------- DATE ------------------------...... <br /> APPLICATIOI`��ACCEPTED BY---- ------ -------------------------------------------------- <br /> DATE------------------------------------------------------- <br /> REVIEWED BY-------------------------- ---- - ---- 7 <br /> .... DATE------------------------------------------------------------- <br /> BUILDING PERMIT ISSUED------- -- ------- -----------------------------------------------------------­ I <br /> t - ---------------- <br /> Alterations and/or recommenclafi s-..-- ------ ——-- ----- - ------------------------------------------------------ ------------------------------------- <br /> -------------------------------------------------------------------------------------------------------------------------- <br /> --------- -------------------- ----------- -- ----------------- ------------------ -------------------------------------------------------------------- <br /> -1------� ; �---- ­------------------------------ -------------------------------- <br /> -------------------------------------------------------------------------- ------ <br /> -------------- ------ ------- ---- ----------------------- <br /> .... .......... ZZI / - ------------- ----------------------- <br /> 7 -1 <br /> ........... --- --------------- ------ --- -- - ­------- -------- ............A/!--------------- ------------- <br /> L& Date-------- ---------- -------------------------- --------- <br /> FINAL INSPECTION BY:_ - -- --•---- --------- r <br /> SA 'JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Maxelton Ave, 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> F.P.120. <br />