Laserfiche WebLink
F---R-OFFICE, CJSE:� <br />:. ------� ------ . <br /> --- ------ - <br /> APPLICATION FOR SANITATION PERMIT Permit No. .C.-_ _ ..�.. <br /> -------- This Permit Expires 3 Year From Date Is-sued <br /> (Complete in Duplicate) <br /> ---------------- Date Issued <br />--------------------- -- <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 /> JOB ADDRESS AND LOCATION----- -ff---'-j6��r' 1V� �--------- <br /> Owner's Name------ -------- R-----------------•. -------•---------••----------- Phone.. <br /> Address---- + C f « -------------------------------=------------•---------------------------- ---------------------=-------•--•-----�--•--•----•---------•--------•----- <br /> 1 . <br /> Contractor's Name-----QW-111K� .. <br /> ------------------•------------------------------------•- •------------••------.. ------•-••------•' ...�------.- Phd�ie--X .{�__�!,}-�4 ------- <br /> Installation will serve: Residence P Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __.L. Number of bedrooms j- Number of baths J_.._ Lot size ____________________________________________________________ 3 <br /> I <br /> Water Supply: Public system ® Community system ❑ Private ❑ _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 /> ES <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: frm foun __. . d <br /> -------------t nearest poCity.. <br /> compartment . Distance ­4a <br /> Liquid � � Capa �e 7 <br /> Disposal Field: Distance <br /> from'nearest well______ _________Distance from foundation___....�'_......D' tance to nearest <br /> lot line.vl- <br /> Length of each line-199- _--�e �-ldv idth of trench.---- ...•:--------=----------- <br /> of lines___.__-._____ g <br /> Type of filter mai�etial..__ :D -1 ___Depth of filter material____ ------- length.......X_V-,-______:_'__..________ <br /> . r <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------- to nearest lot line----------------- V <br /> ❑ Number of pits-_------:-------------Lining material----------.------------Size: Diameter--X.__----------------Depth--------------------------------- CV t <br /> Cesspool: Distance from nearest well-----------------Distance from foundation.-------------------Lining material----------------------------.------ <br /> ._ <br /> Capacity l <br /> ❑ Size: Diameter-------------------------------------Depth---------------------------•--------------------•-__Liquid Ca p ty-------....----------• <br /> •----gals. •< <br /> Privy:; Distance from nearest well-------------------------------------------•----Distance from nearest building---.-.--------------• ------------ <br /> - ------- <br /> Distanceto nearest lot line--------------- -------------------------------------------------------------------------------•---T---------------. ------------ <br /> l <br /> Remodeling and/or repairing (describe):--------- --------------------------------------- ---------------------­----------------------------•-------------------•----••-• -------------- <br /> --------------•--•-------------------•-----------------------------------•--•------------------------•-----•---------------------•-----••--------...----------------------------- ` <br /> ---•------------------•-----------•---------...--------------------------•-------•---------------------------------•-------------------------------- <br /> ---------------------------------- --------------- ------- ---•----•-------------------------------•--------------•--------------•---------••--------•------------------------------------- ---------------------------- <br /> t <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 laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed �� ---•-------------- -------------------- (Owner and/or Conti <br /> By:------------------------------------------------------------------------------ ----------------------------------------------------(Title)------------------------------------------------- -- <br /> (Piot 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.... -•------------------- <br /> REVIEWEDBY------------------------ ------------ ..... ------------------------------------------------------------------------------ DATE----------------------------------------------------------- <br /> BUILDING PERMIT ISSUED------•-------------3---------------------------------------- <br /> --------------------------------------- DATE------------------------------------------------------------- <br /> Alterationsand/or recommendations--------------------------- ----------------•----• •-------------•----------•----------•-••-------•-----•------------------------------------------------------ <br /> FINAL INSPECTION BY:.- /--"F------ ------- ------ ------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> z <br /> E0-9 REVIBED a-99 F.P.DD.2M 6.60 <br /> M <br />