Laserfiche WebLink
L-4 <br /> 9..._ _ ____ A"LICATION FOR SANITATION PEN k Permit No. l..(�.�....... <br /> - <br /> ---------------------- ------ -._--- .-.-.. (Complete in Duplicate) S� <br /> _- This Permit Expires 1 Year From Date Issued Dete Issued . .. ..:d0-� <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 <br /> / compIlianc�ewith County Ordi�once No.. 5499. <br /> JOB ADDRESS ANDLOCATION / frs1Pn ,,F ..- / , /id <br /> { - - - ---------- <br /> ---------------------------------- <br /> Owner's <br /> - <br /> ------ ' -------------- <br /> Owner's Name----- L!LQ<._� .. ------ ----- ------ ----- - - _. . Phone---------------------------------- <br /> Address----- <br /> --------------------------Address----- ......-IV...... -_...4 -------- >---'9-------------­-------------- ------- n-F c -s................-- ------ ---- --- ---------------------------------- <br /> Contractor's Name-.61�?cam i- 11.:. :. .:..:....:..:...... ...5'..._,.... -^------ ------ --------------------------- -..:. Phone---------------------------------- <br /> Installation will serve: Residence F] Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _.. Number,of bedrooms ---3--- Number of baths --�.-.. Lot size L--.-------------- ---_---... <br /> Water Supply: Public systEtm ❑ Community system ❑ Private E] Depth to Water Table >.:;. It J 0 <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam,] Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ 0 <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 /> Septic Tank: Distance from nearest well.- "2_' _Distance frorrn foundation-.%-C''_'-------_Matanal.__--S'C'_..._:,-�!..__...._--...-.---. �"\• <br /> No, of compartments._;.___ � -.-'f..-. __-Liquid depth_..-'_/__._.__--.Capacity_2_,k"..._.- <br /> ----_Size- ------` <br /> Disposal Field: Distance from nearest well '.__.Distance from foundation-_. .,:z.........Distance to nearest lot line-s. ..--...... <br /> �I Number of lines_-- ...... Length of each line..0C-------------------Width of trench.-::. .-------..-------. <br /> Type of filter _.Depth of filter material...1'.9� ---- Total leng+h-.. ..f -"--_---------------------- <br /> Seepage Pit: Distance to nearest well ----------------Distance from foundation---.-.----.-----.-..Distance to nearest lot line----------------- <br /> 0 Njmber of pits--- -_........... ..Lining material.---- _-.------------Size: Diameter.-_-----_--- -__.--Depth______.__..--.--__---- <br /> Cesspool: Distance from nearest well ----------------Distance from foundation_ -------------_.Lining material------------------------------------- <br /> 11 Size: Diameter- -- ---.---------- ---------------.Depth------------.-. _ ........----.._---------------Liquid Capacity-------------------------.-.gals. <br /> Privy: Distance from nearest well--- ----------------------.----__----- __.-Distance from nearest building.-.-. ----------------------------------- <br /> Cl Distance to nearest lot line----- ------------------------ ----- -------------._ ..........---'-----._-------------_ <br /> Remodeling and/or repairing (describe)-- ---- - --------------------------- ----- ----.-----------------------------------------`-----------_--------___........................ <br /> ........................-1-------------------------I----------------- ......... .__..---- --------------------------------------------------------- -------------------------------------------------- <br /> I hereby certify that I prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, La ws rule an ns of the San Joaquin Local Health District. <br /> (Signed)--.-. --- ----- - --i-.--. ---'-------- __----... _.__ - __---------.__---._--(Owner and/or Contractor) <br /> By: - - - - ---- - - --ITitle) - -- --...__.. _.._ rJ <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_411n rl - -- ---- --------------------------------------- DATE.-/. .._'.L-�.-'..--J .......... <br /> REVIEWEDBY----------------------------------------------------------------------- ------ . ..........................._ -...... DATE----- -------------------------------------- - <br /> BUILDING PERMIT ISSUED.------------------------ -------------------------------- ._- ------------------ DATE----------------------------------------------------- <br /> Alterations and/or recommendafions:.................. ------- ---------- ---------------------------------------------_.-------..----------------..-...----------------------------- <br /> j'. <br /> FINAL INSPECTION BY .,_/,'`.:'._ _ . . ✓ . ._ __.. . Data. ✓..'.j ;L.r .-- . ............. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Aye. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton, California Lodi, California Manteca, California Tracy,California <br /> F.P.co. <br />