Laserfiche WebLink
II FOR OFFICE USE: <br /> ---------------- APPLICATION FOR SANITATION PERMIT Permit No. /.�,Z ....... <br /> (Complete in Duplicate) <br /> This Permit Expires 1 Year From Date Issued Date Issued <br /> ------- -- -------------------------------- ---- ©.5.3— ,07o.D7 i <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made(in c^7omp-lliance with County Ordinance No. 549. � �vse <br /> JOB ADDRESS AND LOCATION.-- ' : I �� <br /> --- -- - --- ------------- --- X/---,--r---L---c------------o- <br /> Owner's Name-------------- � •-•----- y_1-`•------.11f4_l1ple— ------------------------------.-- Phone��Z4 _7,/ <br /> Address---------------- •----- ------ <br /> Contractor's <br /> ----Contractor's Name------- ---- <br /> -- _- J <br /> Installation will serve: Residence 0-"'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> �l <br /> ibaths <br /> t, Number of living unit's:'_ _y__ Number of bedrooms_ -_- Number of bathsi-Lot size --------------------------- <br /> Water Supply: Public system ❑ Community system ❑ Private [fl--'Depth to Water Table -------- ft. <br /> p <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Delay ❑ `dobe❑ Hardpan ❑�-�j„r <br /> Previous Application Made: [If yes date____________________) No ❑—New Construction: Yes ❑ No E3---FHA/VA: Yes ❑ No ❑ �.�' <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> ,l <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> �s ❑ No. of compartments---- -------------------Size------•-- - •- -- - tion----•---••--•-�-- - Material---------=-�------�------�------- ------�--� <br /> r <br /> Septic Tank: Distance from nearest well-----------------Distance from found_aLiquid depth---------------------------Capacity________._._____.__. + <br /> Disposal, Field: Distance from nearest well_A?e..___.Distance from foundation__/!' __f-----.Distance to nearest lot he.-�-.--__--. <br /> ❑'� Number of lines ------ ---Length of each line----..�rD------------------Width of trench---4�.--------------------- <br /> Type <br /> - - - -- <br /> Type of.filter material--.- Depth of filter material__ L _'9------- otal <br /> h, j ` length__1.__F <br /> eD---`r-----.------------- <br /> � ----Seep Pit: Dianearest well fr/T nyetoeans�lotl�a2 �! be lumbeeofLining Size: Dto__�'� . © P+ � � <br /> �--- <br /> } <br /> Cesspool: Distance from nearest wet#-----------------Distance from foundation--------------------Lining material__________________________________ <br /> ` ❑ Size: Diameter-- ...Depth ---Liquid Capacity gals. <br /> Privy: Distance from nearest well---------_-----------------------__------------_Distance from nearest building—---------------------------------------- <br /> ❑ --- .: <br /> II Distance to nearest lot line--------------------'-- -------- -------------------------------------�------------------------------------------------------------------ ; <br /> and/or repairing (describe):------___-- l- r�_.____ +-t'fSJL <br /> - - -- -- ------------------- <br /> Remodeling � <br /> l -------------- <br /> II <br /> i I hereby certify that I have prepared thisapplication ad'that`+lie work`wili be'don in accordance with San Joaquin County <br /> ordinances, State laws,._a rules and regulations of the San Joaquin Local Health District. r <br /> {Signed)------------------------------- ,t L�'h -------------------------------------------------------------.-,.(Own <br /> and/or Contractor) <br /> --- -z. - ” - - ----- Title------• ----------------------------------- <br /> lot <br /> - 1 <br /> I Br------ ------------ --------•---- (Title) = ---- - <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-- _ ------------------------------------------------------- DATE--- 'Com•-S--- - <br /> REVIEWEDBY------------------------------------------------------------------------------------------- --------------------------------- DATE---------------L----•--------------------------------------- i <br /> BUILDING PERMIT ISSUED-•----------- ---- --------------------------------------------------------------- ----------------• DATE--------- --------------------------------------------------- <br /> Alterations and/or recommendations------------------------------------------------------------------------------------------------------------n------------------------------ <br /> ----------------- <br /> i <br /> -------•------------ ------ <br /> = -------------------------------------------------------------------------------------- -------------------------- <br /> $ <br /> --------------------------------------- ------ <br /> ------•----- --------------------------------- -----------•-•---•-------------------------------------------------- -----------------------­ <br /> j FINAL INSPECTION BY:---G� %' �' Date , _.: * ^moi <br /> i� <br /> l SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> I� <br /> 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> II Stockton,California Lodi,California Manteca,California Tracy,California <br /> i� <br /> it F.P.C 0. <br /> ip <br />