Laserfiche WebLink
AF%.,„wCATION FOR SANITATION PERMI,.w Permit No. .. i a� <br /> ------- -- --------------------- ----------- (Complete in Duplicate) / <br /> ... This Permit Expires 1 Year From Date Issued 1 . ' 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. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATIO :._ -_ __-Cis,.��_ __-.... --- ..e--_ - E� _--_-__ <br /> L Owners Nam ....................._- <br /> - ----------� -- ----- - ---- --- ------- -�----- Phone------------ ......------ <br /> Address. e- ----------- <br /> - - -- <br /> z t <br /> 1. Contractor's Name------ - - ----- - Phone....................---------- <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other g7-2--z . <br /> Number of living units: ...--- Number of bedrooms 3._. Number o baths ../--. Lot size ------ - � .—...._.._.__..._ <br /> Water Supply: Public system E] Community system El private epth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam lay ❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date I 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 /> Nee Septic ank: Distance from nearest well..._.C4!_"_Dista a/from foundation-____f 0-1____.Material------ ------- --------- <br /> No. of compartments-..__7 ----------- depth-------4L........._ Capacity._.,/_,9_4d .. <br /> n <br /> i <br /> Dispo Field: Distance from nearest well_.,1Q_-.._Distance from foundation.--1.C2.I----..Distance to nearest lot line-,5............ <br /> seeNumber of lines------ _.._.._�j__..._._Length of each -- <br /> ---- ---- of trench___ .------..-__..___._. q <br /> Type of filter material.---_.-KR I------Depth of filter material_._.�_q._`_...-Sotal length---.--/tP:- _. - <br /> a a N <br /> SeepPit: Distance to nearest well Q4�._�Distance ffro foundation --__Distance to nearest lot line.._S_/_.- <br /> r Number of pits..._.....'1.%_.._..__Lining material-_Ui _s......Size: Diameter_...__.3. .��..._Depth_-_AAS.---------_-.--- <br /> Cesspool: Distance from nearest well........:.....:r-Distance from foundation--------------------Lining material-------------------------....__------. <br /> ❑ Size: Diameter---------------------------------De th__------------------------------------ -Liquid Capacity gals' <br /> - <br /> Mee Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-------------.----- I <br /> ----------------- <br /> ❑ Distance to nearest lot line-------------- <br /> ` Remodeling and/or repairing (describe):.------ ----------------------------------------`-------------------------------------..._---------------------------------_--------- <br /> --------------------------------------------------------------------------------------------------------------------- <br /> •------------------- ------------------­-- -----------1--------------------------------------------------------------------------------------------------------------------...........-- ----- <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, les and regulations of the San Joaquin Local Health District. <br /> - - - <br /> See (Signed) ------------------ --------'- - - -------------------------: gid/or Contractor) <br /> By:----- - - ' =wells, <br /> - ---------------------------(Title)--------------- --------------------- ------------- <br /> (Plot plan, showin a of lot, location of system in relation t wells, buildings, etc., can be placed on reverse side). <br /> FQR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY___ ----- ------- ------------------ DATE-�.-L?a---------- -------------------...... <br /> ` REVIEWED BY--------------------------------------------------------------------------------------------------------------------------- DATE----- --------------------------- <br /> BUILDINGPERMIT ISSUED-------------- -------------------------------------------------------------------------------. DATE------------------------------------------------------- <br /> Alterationsand/or recommendations----------------------------------------------------------------__------------------------------------'............-_----------------------------------- <br /> --------------------------- --------------------------- <br /> -----------------------___--------------------_ <br /> FINAL INSPECTION BY:---- Y2. 1.:Zf _...._....... Da+e .' '.rf <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton, California Lodi,California Manteca, California Tracy,California <br />