Laserfiche WebLink
ruK UNICE USE: <br /> E* <br /> --------------------------- <br /> -------------------- ------------------------------------- APPLICATION F6 <br /> R SANITATION PERMIT Permit No. <br /> --------------------------- (Complete-in Duplicate) <br /> - <br /> This <br /> ------------------------------------------- -------------- Permit Expires I Year Date Issued . s­ <br /> I From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a per <br /> ,smit to construct and install the work herein described. <br /> T application is mad I e in compliance with County Ordinance No. 549, <br /> JOB ADDRESS AND -LQC T <br /> Owner's . 0 . ----------- ------------- --------------:--------­---------------------- <br /> rfer S Name---- - ------- <br /> ----------------------- -------- ------------------------------------- <br /> Address----------- Ork 1�1�­ -------------------------- ----- Phone------------------------------------ <br /> -------- -------------/-------------- <br /> r ----I��- -- -�- - ,�­�----4rllail��----------------------------------------------------- <br /> Contractor's Name------�-��- I - --------------- <br /> r •---------- --_3 i <br /> t <br /> I <br /> Phone------------- <br /> Installation <br /> -----will serve: Residence --------- <br /> House 0 Trailer Court [] Motel ❑ Other F <br /> i Number of living units.- --- Number of bedrooms Number' of bathsvV <br /> --- Lot size ---44­1'-01­1­��s—--------------- <br /> Wafer Supply: Public sysfejkm 0 Community system [:] Private n Depth to Wafer Table-7�ft. <br /> Character of soil to a depth of 3 fee+: Sand 0 Gravel E] S6ncly Loam E] Clay Loam E] Clay E] Adobe n—Ma-rdpan <br /> Previous Application Made- (If yes,date____.-_-.-__-...__-) <br /> No E'New Construction: Yes <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: Ff--No Ej FHA' /VA: Yes El No Et <br /> 11' (No septic tank or cesspool p;rmifted if public sewer is <br /> . <br /> available within 200 feet.) <br /> Septic nk: Distance from nearest well-----------------Distance from <br /> foundation...--___---_----. Material- <br /> No. of compartments_.__----------------- ----size____ I -------------------------------------------- <br /> Dispos ? ,I ----------- ---Liquid depth---------------- Capacity----------------------- <br /> ield: Distance from nearest well__.__--_ Distance from foundation-��--'.--'.---.Distance to nearest lot line 7 <br /> E!T Numbeir of <br /> ------ ------ ---------- Length of eac� line-­Z <br /> T�pe#.of.filter material--"Rq- ' t I Width of trench-.Ag��?� -------- <br /> --- --------I-Depth of filter material---le--' - -------------- <br /> t 1 -----------Total long th- ------------------------------- Z, A <br /> Seepage Pit. Distance to nearest well/ ---------I-Distance from foundation--Z,�!............ Distance to nearest lot line,-.A- I <br /> Number of pits---t_---------------Lining Material-!P�&-CZAC------Size: Diameter... ---"----- <br /> Cesspool: Depfk­,2,v----------------------- <br /> Distance from nearest well--------------.---Distance from foundation--- ----------------Lining material-_------------------__----_______ <br /> 1,11 <br /> 0 Size': Diameter----i -- <br /> --------------------------------Depth--------------- ------------- ----------------------Liquid Capacity---------------------------gal--UL---" <br /> Privy, Distance from-nearest.wel)------ --------------------- 1---------------------Distance from :nearest building------------------------------- <br /> n Distance to nearest lot line. <br /> ------------------I-------------------------------------------------------------------------------------------------------- <br /> ----------------------------------------------------------- ----------- <br /> Remodeling and­/or repairing (describe):.----.._--__:----_.1---------------------------------------------------------------------------------- <br /> ---------------------------------------------------------------- m------------------------------------------------------------------ <br /> II -----------------------------------------*-----------------------------------*-------------------------------------------------------------------- -----C <br /> -------------------------------------- ------------------------- - ------------ - - ----------- <br /> that the work will be done in accordance with San Joaquin County <br /> I hereby`Cerffij'4;a­� I have prepared This application and----------------------------------------------------- -------------------------*--------------- <br /> ordinances, State laws- and rules and regulations of the San Joaquin Local Health District. <br /> [Signed)­ 4 <br /> - <br /> -----------------------------­­.:--------------- ----------------------------------------------------(Owner and/or Contractor) <br /> BY:----1. <br /> --- -----------------i--=---------------------- ------------ --------- <br /> • I----------------------------------- ------------------­--ffitle)--------------------- ------- - ------ <br /> (Plot plan, sh 4 owing size of I,ot locafion4 of system in 'relat-io'"n to wells, buildings, etc., can be placed an reverse side). <br /> AU <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY. ..,ka'../V <br /> REVIEWED BY <br /> ---------------------------------------- <br /> ------------------ DATE------ ------------ ----------------- <br /> ----------------- --------------------- -----------------------------f-------------------------- DATE---' <br /> BUILDING PERMIT ISSUED-------•----------------------------------=-------------------------------------- <br /> ------------------------------------------------------------ ------------------ DATE--------------------------------------------------------- <br /> Alterations and%4�r "recommendations:____.'.-_----.--____--_._ -------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------ <br /> ------------------ ------------------------- --------------------------------------------------I ;---------- <br /> 1 1, ----------------------------------------------------------------------------------------- <br /> ---•- <br /> ---------------------------- ---------­---- <br /> ------------------------------------------------------------ ------ ---------- <br /> ---------------------------------------------------:-------------- <br /> --------------------- -------- ------- ...................... --------------------- ----------------------- ----------------------------------------------------------- <br /> ------------------------------------------------------ ------- .... ------------------ ---------------------------------------- ------------------------------------------------------------------------------ <br /> -------------------------------------------------------------------------------------------------- ----------- -------------- -------- <br /> FINAL INSPECTION BY:­ L .- 3- -3- -�, . - <br /> ------ ----- --------------------- Date <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazolten Ave, 300 West Oak Street 124 Sycamore street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca► ,California Tracy,California t <br /> Es 9 REVISED 0-59 3M 3-163 F.P.Co. <br />