Laserfiche WebLink
FOR OFFICE USE: _- <br /> / k <br />_--- -- ---------------- --------_------ - ----------- APPLICATION FOR SANITATION PERMIT <br /> Permit No. !-.. ----• <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 Healfh District for a permit to construct and install the work herein described. I <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION..- _/Q__- - - -�i.... *-'�� `- =1 -1•- -!'-- ``` - <br /> Owner's Name - 15-me- - ------------------ Phone-----------•------------------------ <br /> -------- -- <br /> r 1 <br /> i <br /> ----_��c-Address----------�---•----- -------- <br /> Contractor's Name--- ---------- cs-s..P- J 1T° ' { -----------------------------------------• ---------------- Phone----------------------------------- <br /> I <br /> Installation will serve: Residence, [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ____/__ Number of bedrooms _1_ Number.of baths:-/__.;Lot size _____-_ _ ___ -___ _____________________ # <br /> Water Supply; Public system ❑ Community system ❑ Private [s Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date-----------,------ -) No ❑ New Construction: Yes ❑ 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 Tank: Distance from nearest well----4..---__Distance from foundation__.__0--_______-Material_.__&�T1r .__--_____________________ ! <br /> No. of compartments---------—----------SizeZF_1__;rF.kS-1-..Liquid depth---- -- ------------ Capacity___- a�!_ t� I <br /> / s f <br /> Dispo Field: Distance from nearest well_�7____.__Distance from foundation___�6.________-Distance to nearest lot IineS_�.______._ <br /> Number of lines------/__________ _.. __ Length of each line___�..L2_C/_,�----------Width of french------3__�__-_________________ l <br /> � -� �' - <br /> Type of filter ma. I--_=�'�`� `--_--'-Depth of-filter materi-al----.--1_f_________TotaI length------,f__Q_G_________________________ <br /> Seepage Pit: Distance to nearest well------------------__--Distance from foundation--_______!__----___.Distance to nearest lot line-____-__________- <br /> ❑ Number of pits----------------------Lining material---- -----------__=...Size: Diameter-----------------------.Deptk-------i'------------------------ .A <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 /> Remodeling and/or repairing (describe):----- - ------------------------------------------------------------------------------------------------------------------------------------------ <br /> -------------------------------------- <br /> �. <br /> ..-�. <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- - ------------ <br /> 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 law and rules and regulations of the San Joaquin Local Health District. <br /> {Signed} = ---- -- -- ---- ---- ---------------------- n r Contractor) <br /> a o t for <br /> BY:---------- --••-------- ---------- s-------- --- ---- --------- -- -----------------------------------�--(Title)------­------------------ ----------- ......--------------- <br /> (Plot plan, showing size of lot, location of system in relati n to wells, buildings, etc., can be placed on reverse side}. <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY_ ---- -- ------------- - ------------- DATE____ T/-— �' �_-____ <br /> REVIEWEDBY--------------------------------------------- -------------------------------------------------------------------------------- DATE------------------------------------- <br /> BUILDINGPERMIT ISSUED -------------- ------------------------------ ---•-------------------------------------------------- DATE------------------------------------------------------------- <br /> Alterationsand/or recommendations:------------- -- - --------------------------- ------------------------------ ---------•------------------•--------------------------------------------- <br /> ----------------------------------------------------- ---------- ----------------- ------------------------ ---------------------------------- ------------------------------------------------------------- <br /> --------------------•----------'------- ---------------------------------------------------------------------------------------------•------------------------------------------------------------------------- <br /> FINAL INSPECTION BY:_, .�� -------- -----•----- Date �-------- ---5^-----.-.-------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Ha:ellon Ave. 300 West Oak Street 124 Sycamore Street �^ 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br />' Es 0 REVISED s-59 3M 3-'63 F.RCC. <br />