Laserfiche WebLink
m— FOR OFFICE USE: <br /> ----------------------------------------------- <br /> APPLICATION FOR SANITATION PERMIT Permit No..__/..7____ <br /> ------ (Complete in Duplicate) t Z� <br /> This Permit Ex ires 1 Year From Date Issued <br /> Da#e 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 /> Ibis application—is—made-in-compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION.. <br /> OCATION• I' h , a�� ' <br /> Owner's Name----------- .9 FftF'�-------1_TADRO.1Cvl.-PF------r-------------- - ------------•---------------------------•--- Phone-........----------_--•------_- <br /> Address_------------------------I1.ti.Y..........G3_m+.THHoR _-------------.... ---------------•-•-•----------------•-------------••---------------•--------._.. <br /> Contractor's Name---- ------------------------ =--- ------------------------------------------------ Phone------_-------------------- <br /> Installation will serve: Residence [3--,kpartment House ❑ Commercial ❑ Trailer Court [IMotel ❑ Other E3 <br /> Number of living units- --.I_-- Number of bedrooms 3. Number of baths I---- Lot size ...... �--,r��------------------- <br /> Water Supply: Public system Communy system ElPrivate ❑ Depth To.Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand ravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: (if yes,date--------------------) No P/New Construction: Yes En_-No ❑ FHA/VA: Yes ❑ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS:., <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) _ <br /> Septic Distance from nearest well----,�.Q_---Distance from foundation------/• ------Mat rial---LC._.---151�S1G---- ._._ <br /> 5� x ----------- <br /> No. of compartments______- '-____.__Size_ _ ___ _ ______ Liquid depth------�g,�..--Capacity------- _Q.-_.-._ , <br /> Disposal Field: Distance from nearest well...__.-Distance from foundation----lC-........Distance to nearest lot i;rte.-�� ......- <br /> Number of lines---.. _____---------------Length of each line--v'^ ------------------ h. <br /> Width of trenc -_.__ - ... ___�__._______ <br /> terial-_-_.� --_--------Total length------------f_` ---------------- <br /> Type of filter materia._.�QG�-----Depth of filter ma <br /> Seepage Pit: Distance to nearest 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-------------------------------------------------Distance from nearest building---..---_--_----..-_.---____---_----.----- <br /> ❑ Distance to nearest lot line----------------------- -------•---------------------- ----------------------------------------------- ------------ <br /> Remodelingand/or repairing (describe):--------------------------------------------------------_.---------------------•-----.....•-----_...------.-..•----------_................................ <br /> f -----•-----------------------------------•-------------•--------.......----------•-------------••-•---------------------------•-- <br /> i <br /> 1 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, d r les and r ulafio of the San Joaquin Local Health District. <br /> Si ned <br /> )�r Contractor) <br /> B • ----------------------------------------------------------------------------- ! - - ----------------{rifle)------- r ��L�--`... ..... <br /> Y•-- <br /> [Plot plan, showing size of lot, locafion of system in rel n to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> F <br /> APPLICATION ACCEPTED BY----- --------------------------•--- DATE. = ----- <br /> t. L <br /> REVIEWEDBY--------------------------------------------- ----------------------------------•-----------------------• DATE-------------___----------------------------•----------- <br /> BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE--------__-------------------------------------•----------- <br /> Alterations and/or recommendations------------------------- --------------• -----------------------------------------_--------- ........ ----------------•----------------------- <br /> ----- -- - <br /> --------------- •--------•------._...-----------------•--------- -------------------- ----- --------------------- <br /> - -----------------_--------­-- ------•--------------•-----•------------------..---- <br /> -•---------------------- <br /> •---------- ----- <br /> -----•-------- -- <br /> y <br /> FINAL INSPECT] BY: - Date----- �% <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West oak Street 124 Sycamore Street 205 Wort 9th Street <br /> Lod[ California Manteca,California Tracy,California <br /> f� Stockton,California , r <br /> i E5 9 REVISED S-59 2M 5.62 ATLAS - '�' <br />