Laserfiche WebLink
FOR OFFICErUS�E:7------ - / Vv <br /> 0 J 1. // z' <br /> ` APPLICATION FOR SANITATION PERMIT <br /> Permit No. .............. <br /> _.. -------------------------------------- <br /> --------------•------------------------------....- - {Complete in Duplicate) <br /> -,- - 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 /> _JOBS 86.x,.ADQRESS,AND LOCATION.- .e-- ---- .�`..��!�-_.S�?f��`'�'�.- �t...-----,1".-ff C,1. ---- <br /> . <br /> r . Owner's Name � .f?? _ � .►.i 0-------------- -------------------------------------------- Phone ._s�� Q+ <br /> Address.:. `_ . <br /> -77 <br /> Contractor s Name__ Cl-L��, r �' ... Phon <br /> L <br /> lns'�"WIN,ion will serve: Res dence� Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> i <br /> Number of living units: .__. Number of bedrooms ._9_��lumber of baths I... Lot size Q----•--.!......---� --....... <br /> nit system Private Depth to Water Table ift. <br /> Weer Supply: Public system ❑ Community y ❑ ❑ P <br /> ._'Character of sail to a depth of 3 feet: Sand ❑ Gravel (]"`Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan C1u - , <br /> Previous Application Made: (if yes,date--------------------I NoA. New Construction: Yes E] No J$r FHA/VA: Yes ❑ No [I <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic.tank-or cesspool permitted if public sewer is available within 200 feet.) --- <br /> Tank: Distance from nearest welly _-____._Distance fro9?ndation.- <br /> Septic __._---__.Material.......... ............... .. e .^ <br /> No. of compartments---a.6s___f_ ____ •-Size _'_ {---_--- Liquid depth_�"�'a�._.._-.---Capacity..�P9��`--k � , <br /> Disposal Field: Distance from nearest well_.6Q.___-_Distance from foundation..- -- -f -:'.Di'stance to nearest lot line_....... <br /> Number of lines----- ---- •-------- - ------Length of each line-----�_E1-_j"__ -Width of trench-----cZ.V_�------------- <br /> Type of filter material._._. _: _- Qepth of filter material.--__ _.__Teal length_____..-. _s7.__.__..... P <br /> 41 <br /> Seepage Pit: Distance to neare t well__ _.0---- -_-_Distance�rrfrom foundationl- ___...._.:Distance to nearest lot line................. <br /> Number of pits__ _______.___----Lining material__F:_P_ ------- Size: Diameter_'../- - -----.Depth----__------�------- <br /> tom. <br /> it <br /> Cesspool: Distance from nearest well________________Distance'fr'om foundation---.----------- Lining material------------------------------------- <br /> El Size: Diameter---------------------------------------Depth__'------------------------------------- _ ...Liquid Capacity------------•------------•--gals. <br /> Privy: Distance from nearest well__________------------- =.------------Distance from nearest building_________------____--------_____---______- <br /> . <br /> Distanceto nearestilot line------ -----------•-------•-•---- ------------_--------------`w-.`=-....-----------••------... -------------------­-------- <br /> Remodeling <br /> -- --------Remodeling and/or repairing (describe)--------r\­-------------­- . ------------• <br /> ... <br /> I ----•------- ---•----------------------------------•--"-------------....-------- <br /> _ 1 <br /> ------•----- -•-------------------=---------------------------------------------------=•---------------•-------•------------•----•----...----• -:------------- -- <br /> I hereby certify-fhet I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State law and rules and egulations of the San uin al Health D, frict. <br /> - <br /> -------------------------------------- Contractor) <br /> By:.---------- - ---- ------ - - -----(Title)---------- ............... ---------------------- ---------- <br />` (Plot plan, showing size of lot, location of system in relation to ildings, c., can be placed on-reverse side). <br /> FOR DEP TMENT USE ONLY <br /> !J <br /> k APPLICATION ACCEPTED BY --- `' ------------------------------------------------------------------------ DATE <br /> ..-- ;7 <br /> REVIEWEDBY----------••---------- ---- --- ----------- ------------------------•------------------------------------ -- ------------ DATE------- I------------------------------------------------- <br /> BUILDING PERMIT ISSUED..... . --- --------------••-------------------...------------------ ---- DATE <br /> ,. .tea <br /> Alferafions and/or recommendations------------------------ - ------------•--•----------- - ------------------•-• ----------------•---•--.._...---------------------•------- <br /> --------------- - •-------------------------------------•---- <br /> . --------------------------.--------------------------------------------------- <br /> t- <br /> ------------------------------------ <br /> FINAL INSPECTION BY:-.- -•-- -- ----- ----­------------- Date----------------- <br /> SAM <br /> ---------•-SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 Wast Oak Street 124 Sycamore Street 405 Wast 9th Street <br /> Stockton,California,. Lodi,California Manteca,California Tracy,California <br /> E$ 9 REVISED S-99 RM 5-61 ATLAS <br />