Laserfiche WebLink
FOR OFFICE USE: <br /> ----c� L --- <br /> --------- 14)1171,(_._._.._._./4j 1 _�L APPLICATION FOR SANITATION PERMIT <br /> Permit No. .�...`...........�..... <br /> --------------------------------------- <br /> (Complete in Duplicate) / ��- --Expires Data <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 /> JOB ADDRESS AND LOCATION-----------�-- rte'-.....__S <br /> ------------------------------------------------------------------ <br /> Owner's Name--..---'---------------e ........ • -------- `>� ' '� ---- --------------------------------------------- Phone__"C,_ -.g k <br /> Address-------------------- <br /> -- ----�---------- <br /> - --•------------------------------------------------ <br /> Contractor's Name = 'Q -------------------------------- Phone................................... <br /> Installation will serve: Residence [a Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ..�l.. Number of bedrooms __-_- -Number of baths ..._ Lot size ----- <br /> ---- ..l-----------------....... . <br /> Water Supply: Public system [9—Community system ❑ Private ❑ Depth To Water Table ........ ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam D---Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date___________________ 1` No [3.—New Construction: Yes ❑ No E3--FHA/VA. Yes ❑ No.�] — <br /> TYPE OF INSTALLATION AND SPECIFICATIONSc �1 <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well_.._.....Distance from foundation.......`-,a-------Material-----_. ._._ <br /> -- _\ <br /> No. of compartments----------'L.�____.___Size______.� , Liquid depth---.------Y___-.-----_Capacity..........----------- <br /> Disposal Field: Distance from nearest we€I.... _..._Distance from foundation......7f:-�5°.....Distance to nearest lot line-___---__ <br /> t!� Number of lines------ -----------r--------------Length of each line_-_-_-_-__--�'_j5!_-_--.Width of trench-----------------2- -_--__----_ <br /> Type of filter Depth of filter material-_,f,IK-`'_---Total length.............sT:--._-___..._....__ <br /> Seepage Pit: Distance to nearest well------ ---------Distance from foundation-__.__ __.Distance to nearest lot line--------1--R <br /> W . Number of pits--------- _----_-___Lining material___e�_ , _.Size. Diameter--_ ,Depth-------2--%,r`................ <br /> Cesspool: y Distance from nearest well------------•--_-Distance 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 to Ime- --------- ----------------------- i <br /> Remodelin and/or repairing (describe):-----/ �A✓---------- dr_,T� /� •_____�E,A�- .- -_-- <br /> %Z ____........tas= -------- y '^=ls�y IN---------------Rf-----------1� . <br /> i"•E+-ra .?�cr�a -- C --- ---- . . ........... --- <br /> hereby certify that I have prepared this application and that 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 /> Signed ? ............................(Owner and/or Contractor) <br /> 4 � <br /> -t/ -/�_-- . --------------------------------------------(Title}------------------------------------------------- ------------- <br /> ' r <br /> (Plot plan, showing size of lot, location o sy em in relation to wells, buildings, etc., can be placed on reverse side). <br /> FO EPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY - -s-------------------------------------------. DATE-•--------- <br /> REVIEWEDBY------------------ ----1- ---•--------- ---------------------------------------------------------- .......... DATE__-----•-••-------•-- ----------------------.--_----..---- <br /> (BUILDING PERMIT ISSUED-+=--------•".'...............•-- --•- .....------••--------------•-----•-........-•------•­----•... DATE------------------------------------------------------------ <br /> Alterations and/or re ommendatio :._----.--- ---= --------- --------- <br /> -•-•------ / ::° z- ' -��3�--- .-.------ <br /> ------------------­------­- <br /> ---- .f -s- 5 <br /> / ,� -r •>-s/�=---....�...:: 4----------------- <br /> --------------•---••.....................••- --------------------------------------------------------=---------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------•-------•--I---- ---------- -------- <br /> ----------------=-`'------------ -- ---- - <br /> FINAL INSPECTION BY:. ---- ... -=---------- •.� Date-------------- ��� '-'---------- -----•--•-- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Srrest 124 Sycamore Street 205 West 91h Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 8.59 2M 5.62 ATLAS <br />