Laserfiche WebLink
NJK vrriLt UZ)t: A <br /> ................. ........ .......... .. .. .... . .. �4 f� ■ <br /> ....... . <br /> LICAT10N FOR SANITATION PE T Permit No. ',= f-r <br /> (Complete in Duplicate) <br /> This Permit Expires l Year From Date Issued "' }` ` Date Issued <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 /> Z33 f z5• uJ av,os c.-, ,"- • <br /> JOB ADDRESS AND LOCATION -= :: ' '--f -------------- <br /> Name--- - . l - . <br /> ------------------------ ..... ......... ..........---------------- ......... .... Phone.----------------------------------- <br /> Address <br /> - -•------------- - <br /> Address------------ ------ ---------------- ----=--= ._-------------------------------------- -------------..--------------------------I- ...---.._-.... <br /> Contractor's Name... �* ' rW --------------- - ---- - - <br /> - ------- ------------------- ---------------- Phone------------------------------ <br /> - - ------�- <br /> Installation will serve: Residence 01 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -r� Number of bedrooms ----!_.. Number of baths ---1. Lot size --, `--_.-: -------- --------------........ <br /> --- ------ <br /> Water Supply: Public system ❑ Community system ❑ Private Eg Depth to Water Table ft <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [❑ Hardpan-fl <br /> Previous Application Made: (If yes,dote- -- ---- -------- ) 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.................Distance from foundation--,...............-.Material ........................----------------__-----, <br /> ❑ No. of compartments_-_ „------ ----------Size-------------------- --------.-_Liquid depth---------------.. ........Capacity----------- --,-_ -- <br /> a <br /> Disposal Field: Distance from nearest well................. Distance from foundation....................Distance to nearest lot line----------.-..... <br /> ❑ Number of lines ------ .. ......... .......Length of each line------------------------------Width of trench.----,---------------- ------------ <br /> Type of filter materia --- ____.----- Depth of filter material----------------- - ---Total length--------------,-__------------------------ <br /> Seepage Pit: Distance to nearest well---/t..o..........Distance from foundation-0------_.--_..Distance to nearest lot line`•?-------------- <br /> _ -• '`"-� <br /> ❑ Number of pits -- -.'.-- - - -- --Lining material..-O-,t- ...... Size: Diameter._.._ ..- -, ,-, --. Depfn-_-:.,i........................ <br /> .. <br /> Cesspool: Distance from nearest well ..._- Distance from foundation................. ..Lining material-.-___..........................-_.. <br /> [] Size: Diameter- ....... ..... ................Depth------ -------- -. ................... .-...-------Uqu-d Capacity-------------- -------------gals. vi <br /> Privy: Distance from nearest Well----- _---__- Distance from nearest building ---- ...........---------__.---.-.-.--. <br /> ❑ Distance to nearest lot line.. ... ........................... .... . --------------- ------- ------- ......... .-----------_ ------------- .............. j`(1 <br /> Remodeling and/or repairing (describe): _ '-'- ° = -------------------------- ---• - --------, <br /> -------------------------------- ------------------ ---- -- ----------- ----------------------------------------------- --- ------------------------- ----- ----- ------------- n <br /> P <br /> -1 <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 laws, and rules and regulations of the San Joaquin Local Health District. !� <br /> (Signed)•---• --------- '-----`-'1-------------------------- - ----------------------- ----- .....................(Owner and/or Contractor) <br /> By--------------------------;= --- -------------- --- --------------------- ------ ------(Title)----- --- - - .. .......... <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 -. DATE----------= - --------- - <br /> REVIEWEDBY------------ - ...... ......................._......._. ...... . ----- -... ... -------- ------ DATE----- -- <br /> BUILDING PERMIT ISSUED-------- ------ DATE----- --- -- ----- ........... ---- - --- --------- <br /> Alterations and/or recommendations:- -..............._.... ---- - - - - .. ... ... ..................................................................... ................. •--............ <br /> .................................... . ... ..... - -. ......... ...-...----- ----............. _. .................- ---------- --------------------------- -------- - ----.......-......-.-....... <br /> ..... ............ . . . . ........ --- ..... - ... ................. ..... - .._..._.... -- .-...-- ------ --- ------------ --------- - ....----------.----- <br /> FINAL INSPECTION BY: Date - ........... .............................. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 C Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stacklort,California- Lodi, CoNfornia Manteca, California. Tracy,Cohfornia•-- <br />