Laserfiche WebLink
R OFFICE USE: :. <br /> �----------------/�-fit ,� ` <br />--------------------------- ------------ ---- - ----------- <br /> - APPLICATION FOR`'SANITATION" PERMIT Permit No. <br />--------------'<.---------- ---------------- --------- (Complete in Duplicate) 1 <br /> „ pate issued ---�__-- <br /> ,1.--- --- - __ _ -.__ This Permit Expires 1 Year From Date Issued' <br /> Application is herebymade to the San Joaquin Local Health District for permit to construct and install the work herein described. <br /> This]application is made in compliance with County Ordinance No. 549. �Q ! <br /> J09 ADDRESS AND LOCATION----------`f -------�- ........... ` ----------------------------------------- ----------- = <br /> Owner's Name--- -/7''_A-------- - -•'-'c F-;!^ —------------------- ------------------- ----------- ........F--------------------- Phone--�/ <br /> !- ' <br /> Address y •/%�� - = ----------- <br /> Con ..f �S --- <br /> tractor's Name------ ---- --- -�--+'�-------------=----1-----------�----��r.------------- -------------------------------------- -- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _/---_ Number of bedrooms _ <br /> Number of baths - ----- Lot size --- _ ----------------------- <br /> ,? <br /> Water Supply: Public system [ Community system ElPrivate ❑ Depth to Water Table ........ ft. <br /> Character of sail to a depth of 3 feet: Sand ❑ Gravel L] Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe El"Hardpan ❑ <br /> i <br /> Previous Application Made: (if yes,date- ---------- ---) No New Construction: Yes ❑ No ©- FHA/VA: Yes E] No EEt" <br /> N. <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if,public sewr is'available within 200 feet.) <br /> No. of compartments p <br /> t - Liquid de <br /> Sej'fic Tank: Distance from nearest well�s�__"Distance from foundation_ _`__._.Material_...-"""-___._.._-_____________ _____________ <br /> � -------- • -- q th---------------- ---------Capacity---------------------- <br /> - p � <br /> Disposal Field: Distance from nearest well__/-I�s..7-- --_Distance from foundation---/.a._""".----Distance to nearest lot line--_____________ <br /> 4' 7' des S <br /> Number of lines-------------A----------------Lent of each line------------------ lr------Width of trench"-----z______.___""_.--------- <br /> Type of filter material__diF7 A,_-_Depth of filter material----I.X-----------Total ---------------------------- jl <br /> Seepage Pit: Distan(fe to nearest well—_A/A -----------Distance from foundation-__/ ------------Distance to nearest lot line_s __________ kA <br /> le- Number of pits_-`-'"/'`----------Lining material."i/�o c_/C.----Size: Diameter----�3-------- <br /> ------ <br /> Depth_"--��--------------- - -- <br /> Cesspool: Distance from nearestwell__---------------Distance from foundation....................Lining material....""-...--_..___----_.______-""-__ <br /> Size: Diameter-----------------------•- ----------Depth--------------------- ----- ---------------- ------Liquid Capacity-- ------------------------gals. <br /> - i - <br /> Privy: Distance from n ell-----_---' - ----------------------------------Distance from nearest building--------------.---------_----------_---. <br /> ❑ Distance to nearest lot line-------_------ -------------------------------------------------- ----------------------------------------------•----------------------- 9r <br /> Rejnodelin and/or repairing describe <br /> i g / P 9 F - ------ ----;- <br /> ---------------^-^- -------------------------------------------------------- <br /> R-2-9, <br /> --------------- "-----------------------------------------------------------------------------------"`-------------------""`"-:.r----------- <br /> --------------------- r <br /> -------------- <br /> ----- -��' --------`` `'t f/--. - �°`fz----•-----------------------------------------------------------------------------=------------ <br /> ----------------------------- - -- <br /> •------------------- ------------------------------------------------------------•-------------------- <br /> f I 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 /> -----[Owner and/or Contractor) <br /> (Signed) -------� -- - - -- - ---- ..._r ----------- <br /> By:--------- ` --_ = ------------------------------------------------------------- --------(Title)-" ----------------------------------._. ----- - ---------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> ! FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-------- - ------- -------------------------------------- DATE �1 _ <br /> REVIEWED BY--------------------------- - --------- -- <br /> DATE <br /> BUILDINGPERMIT ISSUED.--------------- ------------ ----- - ------ DATE.----------------------------------------------------------- <br /> Alterations and/or recommendations:_ ----- -----------��-�----- --------•---------------"•---•---------------------------------------- ------•------------ <br /> ----:"-•------------------------------------ -------•----------------- - ----- <br /> :. 3 ---------------•------------------------------ ------ --- ----------------------------- <br /> ) ------------------------------------------------------------------------------------------- <br /> 1 ---------•--------------•------------- ------------------------------------------------------ <br /> a . ,5�--------------------------- ------------- <br /> FINAL INSPECTION BY..------. G--_ '! ----------- ---------- -- Date...... <br /> y <br /> 1 - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haselton Ave. 300 West Oak Street 124 Sycomore Street 205 West 9th Street <br /> i <br /> Stockton,California <br /> Lodi, California Manteca,California Tracy,California <br />