Laserfiche WebLink
i Parmit No. <br /> APPLICATION FOR SANITATION PERMIT <br /> Duplicate)(Complete in Dupli ) Date Issued ---- ---- <br /> ii <br /> Application'is hereby made fb the San'Joaquin Local Health District for a permit to construct and instal the work herein described, <br /> m1acle in compligrice ;vith County Ordinance o. 549. <br /> 1.4 <br /> ------- ----------- ------ --- <br /> JOB ADDRESS AND. LOCATION. . - ------------ <br /> ------------- Phone Owner's Name---- --- ------------------------------- ----------------------------- <br /> --- ------------ ----- <br /> f-. Phone-- <br /> -7 --- --- - ------ <br /> /-------------I------ -------------­------ <br /> -------- ------------- <br /> Address------ ------- <br /> Contractor's Name-------- <br /> Nin's'Aallafion will serve�: Residence. Apart ant House ❑ Commercial [-] Trailer Court [I Motel ❑ Other El <br /> s Z- Lo Isize ---------------------------- <br /> fNuriiber of living units:cP42__ Number of bedrooms------- Number of bath <br /> Private 0 Depth to weer` .,,D, _sft. <br /> [I <br /> );�ater Supply: -Public-�,system Community system 0 <br /> Character of soil to a �depth of 3 feet: Sand Gravel [] Sandy Loam El Clay Loam ❑Clay 0 Adobeo Hardpan El- <br /> Previous Application Made: ,,Yes E] N <br /> Nc" i <br /> New Construction: Yes [) No <br /> FHA/VA: Yes <br /> TYPE OF INSTALLAT16W41NID SPEC I FICATIONS: <br /> (No septic fank <br /> or'ceI sWool-permit.te 4T.i_f public sewer is available within 200 feet.) <br /> - _ <br /> pti <br /> is ance from"�J,6undation--;7//-*7--/--I <br /> Tank:--Distance i from nearest t Material---- ------ <br /> -e. ._._------Liquid dep�h__.__y__1--------------Capacify-------:74��------ <br /> c0' mpartmenfs_____ °I I.N., <br /> No. of I----------------- % -_"Y <br /> p"I'Fie I d- Distance from nearest well---- ------------Distance from foundation....................Distance to nearest'lotdine--_.._...._----_f each I�he---------- -.Widthoftrench---------------------------------- <br /> Len th o ;..... - <br /> El Numbe'r..of-line.s. . ­ -1 — — �­ <br /> Type of.filter material-------------------------Depth of filter material-----------------------Total length--,----------------------------------- <br /> o d fi <br /> Disfance'to nearest wejv_s__-v_*--------Distance from f un a ion- -----Distance to nearest lot line__'A,1�---------- <br /> Seepage Pit: 1, 11 V, <br /> Number'of Its..---)--------------Lining mate Size: Diameter--------4tQ_"__De'pfk____-_4,'f1� ............... <br /> X I I ,\ <br /> Cesspool: Distance from nearest well.................Distance from foundation_...______.....__Lining Lining material------------------------- ----------- <br /> Depth---------------------------------------------------Liquid Capacity----------------------------gals. <br /> El Size: Di�meter-------------------------I------------- I <br /> *Privy: 6stance from nearest well-------------------------------------------------Distance from nearest building----------------------------------------- <br /> ❑ ,,Distance to nearest lot line- -------------------------------------------------------------------- ------------------------- -----------------r------------------------ <br /> h <br /> an� ------ ------ --------- --------- --- ----- <br /> Remo d/ <br /> /or irep in.9 escribe . . ..... <br /> ------- -- -------- ---- ----- --- ---------- <br /> -------------- <br /> ------------- -A ------ ---- - -- _ ------ ----------- ------------------- <br /> ----- ----------- <br /> - ----- --- - ------ ------------------- ----- <br /> ------------------ ---------- ------ --- --- <br /> eill be don in a rdance if San Joaquin County <br /> I h�ereb_cerfifyj' that I have prepared this applitation and that.the work * 1. <br /> if Local Healf Dis ict. <br /> ordinances, )Iat�,Taws, es and regulations of the;San Joaquin <br /> OW or Contractor) <br /> {Signed --- <br /> ---- ------- - ----------------- ----------------- <br /> . ........... <br /> ------------ ------ - - -- -- ---------------(Title --------------- ------------ -- <br /> -- ------------ <br /> ------- ---- ----- <br /> By:------ ---------I- ace s <br /> !:(PI6+ Plan. showing S'Ixe of lot, loca ion syst in rel i to wells, buildings, etc., can be d on re ei e e). <br /> i. H A <br /> FOR DEPARTMENT USE ONLY <br /> 7A... I------------------------------------------------------ -------------- <br /> ---------- <br /> APPLICATION ACCEPTED B --- ----------- ----------- <br /> REVIEWED BY--- --------------------------------------------- -- -- -- ------------------------------------------------------- DATE.------- <br /> -- <br /> BUILDINGPERMIT ISSUED------------ ---------------- ------------------------------------------------ DATE--------------- --------------------------------- <br /> ' Alterations and/or recommendations:------- -------- ------------------------------------------------------------------------------------------------- - ---------------------------------------- <br /> ---------------------------------------------------- ---------- ------------------------------------------------------------------------- ---------------I------ --------------------------------------- <br /> ----------------------------------------------------------------------------------------------------------------- <br /> --------------------------------------------------------- ------------------------------------------------- <br /> 4 ----- ---------------------------------------------------------------------------------------------------------- ---------------------------- <br /> --------------------------------------------­ <br /> ----------------------I------ <br /> --------------------------------------- ------------------------------------------------------- ---------- ----------------------'--------------------------------------------- ----------------------------- <br /> ................................. L <br /> --- ---------- ............. <br /> FINAL INSPE'CTION ZY�------- - ----------- ---Ni!:!�-------------- Date A� <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT' <br /> 132 Sycamore Stree4 814 North "C" Street <br /> 130 South American Street 300 West Oak Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M Revised 1.57 F-RCO- <br />