Laserfiche WebLink
FOR 0�, FICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ' ' ' � Hv ]�- <br /> -- (Completer ~~r~~'~/ Dm�� |sw,m6 -�l�. �-'� <br /> � <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 /> J[)8 ADDRESS AND LOCATION.......... ........... .--- ................__________________.. <br /> Ownm/o Name----.-. -_.-' �°*�~~. ----------------- <br /> Address....................................................... ^------------'-------'------'---'-------------''''-----' <br /> Contractor's Nome--.---....'.- ----------'-_--.---.--.--. Phone----------------------------------- <br /> Installation will <br /> ---'__-.-----'|nstmUmtionwiU serve: Residence �partnonf House [] Commercial [j Tr i|mr Cwvrt [] Motel [3 O+her [] <br /> Number ofliving units: Number ofbedrooms Number of baths -/... Lot size _-- ............. <br /> Water Supply: Public system �Cnmmunity system 1-1 Private Fj Depth To Water Table 3-0�- ft. <br /> Character of »mU to m 6mmfh of feet: Sand E] E)nmve| [] Sandy Loom [] Clay Loam F]--C|uy [] Adobe[] Hardpan C] .| <br /> Previous Application Made: (if yes'6ate---� �--'> No �,-�NewConstruction: Yes [] No [3--FHA/VA. Yes E] <br /> ' � <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> ' (Nm wwmtiw tank or cesspool permitted if public sewer is available within 200 feet.) ` <br />� <br /> Septic Tank- Distance from nearest well.-----—------Distance from foundation---Z--2q--------Material - ------- <br /> No. <br /> .- <br /> No. of compartments---------7---��--.Size...... Liquid 6ep+h-----&�..---.Capacity.... <br /> u����'��-' <br /> Disposal Fin|6' Distance nm*m,t w�|| ��� Di,tunc� from foundation ���� D|��n�e toneo, st �� Unm---�-�' -- -� -- -' - - 1 <br /> ------- <br /> Number of |i Length ofeox6 line-__"��.��---Width nff",nck-._-.-��r�-_.. <br /> Type of filter mo+e�uL. Doo+ of fi|h,r mater-iaL~^r-,r......_To+u| length--------------Jt.-.!;?�------------------ � <br /> Seepage Pit: Distance to nearest � <br /> � L—°����. foundation..- Distance to nearestlot- <br /> line- - <br /> . -�L--- <br /> Number of pHs -..'^x'---Lining material-- Size: Dia mete cx� 4lo-Depth-----------6----- <br /> Cesspool: Distance from nearest well _'--'--Distance from foundation-''''-'—Lining material � � <br /> 0 Size: Diameter------------------------------------- Depth------------------------------------------------------Liquid Capacity............---------------gdIo. v . <br /> Privy Distance from nouns+ well--------------------------------------- ---------Distance from nearest building.'---'-_--__.--'-- <br /> [] Distance to nearest lot line------------------------------------------------------------------------------------------------------------ ---------'- \J <br /> � <br /> Remodakng umJ/nr repairing (describe):--------------------------------------------------.---------------------------------------------------------------------------------------------- <br /> ------------''''-'''--- ----------------------------------------------------------------------------------------------------------- --- ------------------------------------------------------------------ r <br /> ---'--__---.__--_.----___..__..__._----'-_---_._--_-:-------------------------------------------------------------------------- --------- <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------'�- <br /> I hereby certify that I have prepared +his applicationan6 that the work will be done lnaccordance with Sao Joaquin County . <br /> ordinances, StWe'laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed ------'--Xvlvv� ------_---- and/or Contractor � <br /> By:....................-------------------------------------------------------------'---'---------- ----r'- ---------------------------- ---------- -------- <br /> (Pic+ plan, showing size of lot, locwfion *f system in relafiw to �ells, buildings, etc., can be placed on reverse side). / <br /> FOR DEPARTMENT USE ONLY � <br /> � <br /> APPLICATION ACCEPTED DY'- ----------���*.v�� -r����'--'-_._-__--_. DATE�-_- �--.. . <br />� REVIEWED MY''-'_-'--''-----'-'^~ '-'''---'-''---''-----__.''-_-'__ DATE------------------------------------------------------------ ' <br /> BUILDING PERMIT ISSUED--------------------------------------------------------------- ------------------------------------ DATE--------- <br /> -^ - <br /> --' ------------------------- <br /> ��� � ���� �� " �' �� �c� ���.���� ' <br /> --. -- .�=�~.-- -.. .. -' .- --- ' --' \ <br /> -'_-- ---�-__-.--_---_--._---.---------._----. � <br /> . <br /> FINAL |N-PECT|{}N BY--- '� �~—��, - ^+� Date----------- "��-�r�'-'-'-'-'--'- ' <br /> ' | <br /> SAN ��*��'U|N LOCAL CU�T��� <br /> - <br />� �"� o�°� nvww��npxsr°� �o��"�"*���* uos�°mwm��° <br /> 1um m�°a�" ��* o�w� <br /> � m,/� <br /> ' <br /> Stockton,California Lodi,m"x���+� m""�"m.cmx �� n�x'. / �/" <br /> _Enn REVISED B-59 zw 5'6e xrL^s <br /> i <br />