Laserfiche WebLink
FOR OFFICE USE: I- . r <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> ------ -- ------------ -- ---------- --- -------- (Complete in Duplicate) Date Issued <br /> ----- This Permit Expires 1 Year From Date Issued <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 compliance with County Ordinance No. 549. <br /> jj� -�^—v. �.] p { IJ <br /> JOB ADDRESS AND LOCATION------- ---- � Cho-------- T SEI------ ---------- <br /> Owner's <br /> --•-••--Owner's Name--------- _ -uicm------------------------------------------------------------------------ --------... Phone------------------------------------ <br /> AddressAhl------ --------- ----------------------•---------------._...----------- --------•------•------- ------------- <br /> Contractor's Name--------------------- ----•-------- -- Phone...... ......................... <br /> Installation will serve: Residence ❑iO'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel E] Other ❑ <br /> Number of living units: ---[-.-. Number of bedrooms .3__ Number of baths -_..�.. Lot size ..�.!_1 a7e----------------------------------------- <br /> Water Supply: Public system ❑ Community system ❑ Private E?­<epth to Water Table ........ ft. <br /> Character of soil to a depth of 3 fee+: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam 0 Clay-L21""Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date--------------------I No 'New Construction: Yes ❑ No [RO" FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: ,Maw- 1ov <br /> r .�—_,!.r(No,septic tank,or,cesspool_permitted if_public sewer�is.available within-200,feet.) t <br /> Septic Tank: Distance from nearest well----- Distance from foundation..---/V-.......Material...-----.Cp_xC"�------_.__-_-. <br /> [� No. of compartments.......... - --------------Size-----qts--'� ---=---Liquid depth.......{ �-----.-----Capacity_J_.7Zr-U-_4a.. <br /> I Disposal Field: Distance from nearest well.-.-.$s......Distance from foundation----LU----------Distance to nearest lot line..,l�.t�._.... <br /> s�-----------------Length of each line of french - ----------------- <br /> I ❑�' Number of lines............... g �R <br /> Type of filter material...t .- __--.Depth of filter material---_lky.-----_Total length------..o'�_ ._......_------------- <br /> Seepage Pit: Distancetonearest well----------------------Distance from foundation---.--------------- Distance to nearest lot line-____________-. <br /> ❑ Number of pits----------------------Lining material------.------------.---Size: Diameter-----------------------Depth-.,-.---------------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material.----------- ----------------- <br /> Size: Diameter-------------------------------------Depth-------------- ---------------- -- -------Liquid Capacity_ ---- gals. <br /> Privy: Distance from nearest well-------------------------------------- from nearest"building_-_..-.--.-................-.-..__-_.-.__ <br /> ❑ Distance to nearesf,lot line - --- -- ------ ----------- --- - -------- ----------------------------- -----------_----------------------------------------------------- <br /> Remadeiingand/or repairing (describe)------ -- -----------------------------------------------------------------•-------------------------------------------•--- -------------------------- <br /> - <br /> ----------------------- ------------------------------------------------------------------------------------------------------------------------------- ----------- <br /> -- -- - -------------------•----•--- -------------- ------------- <br /> I hereby certify that I have prepared this application and +hat the work will be done in accordance with San Joaquin County ! <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> f <br /> (Signed) - ------------- ------------------------- -------- ----------------- Owner and/or Contractor <br /> -� <br /> _ -_----------Title v. <br /> LL (Plat plan, showing size of , location of sys to relation to wells, buildings, etc., can be placed on reverse side). <br /> I <br /> FOR EPARTMENT USE ONLY <br /> APPLICATION ACCEPTED ----- ----------------------------------------------------------------- DATE------- -�` 7---------------- <br /> REVIEWEDBY-------------------- ------ ----------- -- -------------------------- /---- ------------------------------------- ----- DATE----------------------------------------------------------- <br />' BUILDING PERMIT ISSU -------------- -- ---------r---------------------- DATE----------------- ------------------------------------------- <br /> Alterations and/or recommendations:-_ GZ <br /> t / [?> - a' ?-------------------------------------------------------------- ----------------- <br /> --------------------------------------------------------------------- ------ --- ---- ----------------------•----- <br /> -_ -� -------------- <br /> - -- .�" (�k-`-- l�il 1it� _. __!,(a . - - ( `--------------- <br /> 1-6 <br /> -- ------------------------------------------------------------------------------------------- ------------------------------------ -------------------------------- <br /> FINALINSPECTION BY----------------- .-- --------------------------- --- ------- Date- ----- ---- ------------------------------ ---------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Nasellon Ave. / 300 West Oak Street 124 Sycarnare Street 205 West 9th Street <br /> Stockton,California GGG Lodi,California Manteca,California Tracy,California <br />