Laserfiche WebLink
FOR OFFICE USE; <br /> ' = -1�------ 11 1 + <br /> APPLICATION FOR SANITATION PERMIT Permit No.a-Q-------.. <br /> ------------------ -------------------- ----------- (Complete in Duplicate) <br /> - � Date Issued J_'_9____W <br /> ----- ------ This Permit Expires 1 Year From 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 /> I <br /> -fl <br /> JOB ADDRESS AN OCATION___�_ __�_ ---- <br /> Phone-a-6-5--- fz-Owner's Name._ <br /> Address-----------•-------- ,------- - ------- ------------ ------•-•-•-------- � <br /> S Contractor's Name-------------•------- ----- Phone'��� 7®-7------ <br /> Installation will serve: Residence % Apartment House ❑ Commercial ❑' Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units:—__I Number of bedrooms-75� Number of baths _-- Lot°size_��----_ <br /> Water Supply: Public system Cl .Community system F] private 5e Depth to WateryT ble 8.§7ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay.Loam jX Clay'❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date--=------------------)�No I] � 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 /> 6xtS+104e' No. of compartments-------------- ------ --Size--------------------------------Liquid depth---------------------------Capacity------------------- <br /> Disposal Field: Distance from nearest well.-ISV-_----Distance from foundation_-/_�- -_____.Distance to nearest lot line____�_�________ <br /> 49' s f/ <br /> Number of lines___3 �_ Length of each line__-_ _�_ ____ Tr.__.Width of trench-____ ___._-_-----______-_ <br /> Type of fi{ter material__.__- _-- -_ - -.___Depth of filter material--_- ---�_--_Total length____ _Q_____________________r__ <br /> Seepage Pit: Distance to nearest welll !_. -------Distance___-- ndation__J_ �_____---.DLstan e to nearest 12t line--_-_.`70__--_-_ <br /> Omf <br /> / ? -- - 5 ----------- <br /> - ---- - --Size: Diameter--- ...--------DepnNumber of pits--Thk _)_Lining material_-_ _. - <br /> Cesspool: Distance frominearest well-----------------Distance from foundation------------------ material__-_____----------__-_____--__-_-- <br /> ❑ Size: Diameter------------------ -------------------Depth------ ---------------------------------------------Liquid Capacity------------------------ -gals. <br /> Privy: Distance from Inearest well------------------------------------------------Distance from nearest building------------------------------------------ <br /> ❑ Distance to nearest lot line------I------------------- ----------------- -------------- - --------------- ------------ --------------------------- ------- <br /> ---------------------------- <br /> Remodeling <br /> ------ <br /> Remodeling and/or repairing (de scribe):------ `F ------ - ------- " 3 <br /> ---------------------------------------------------- --------------------------------- <br /> --------------------------------------------------------------------------------------------------------- <br /> I ------------------------------------------------------- t ------I------------------- ---------------------- ----------------------------------------- ----------- <br /> t -----------------------------­ -------- <br /> ---------------------------------------------------------------------------------------------•-------------------------------------------------------------•--------------------- <br /> I hereby certify that I ha v epared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and r es and rea�ulatia of the San Joaquin al Health District. <br /> (Signed}-- ------------------------ <br /> ----- ------- ---- (Owner and/or Contractor) <br /> 1 -------- - <br /> Title- -- ' <br /> sY '------ -- ------------ ( ) <br /> (Plot plan, showing size of lot, location system in rel Ion to wells, buildings, etc., can be pl ed on reverse side). <br /> i FOR DEPARTMENT USE ONLY <br /> y, <br /> APPLICATION ACCEPTED BY - Cil ------------------------- DATE------- ��----�--------------- <br /> REVIEWEDBY_-. DATE----------------------------------------------------------- <br /> BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------ ---------------------------------------- ------------- <br /> Alterations'and/or recommendations:------- ----------------------------- ---------------------•--------------------------------------------------•------------------------------------- --------- <br /> ------------------------- -----•-----------------------------•-------- ----- ----------------------- ----•------------ -------------------- --------------------------- -------- --- - ----- <br /> ' <br /> ------ -------------------------- ----------------- ------ --------- <br /> r,. - <br /> --------•------------------•----------- --------_---------------------------------•---- ----------------------------------------- <br /> --- -------- <br /> i ----------------------------------------------- <br /> FINAL INSPECTION BY:--------- -•---�-r----------- Date-_.-._. � /.--- �" <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Are, 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> t_?s Stockton,CaliforniaLodi,California Manteca,California Tracy,California <br /> f <br /> i <br />