Laserfiche WebLink
1 %as,rik—c u0c: <br /> .......................................................... <br /> ................................................... APPLICATION FOR SANITATION PERMIT Permit No. .42p <br /> ...................... ....... (Complete in Duplicate) <br /> . <br /> This Permit Expires 1 Year From bate Issued Date Issued <br /> Applica-tion is hereby made to the San Joaquin Local Healfh District for a permit to construct <br /> This application is made in cSrnpliaii!;e_w�h County Ordinance No. 549. and install the work herein described. <br /> 011- (70-03 <br /> JOB ADDRESS AND LOC�A <br /> _T�ONJJ <br /> Owner's Name........ .............. <br /> .................................. --_---------­--------- Phone <br /> Address........ .. . ... <br /> ----------'Z_ <br /> 4.r/........................................................ ----------- <br /> Contractor's ------- <br /> -------------------- <br /> ........... .14Z 21�.A.: <br /> Installation will serve: Residence �iApartment House [oe <br /> ..........-------- <br /> Commercial E] <br /> Number of living units:�------- Number of bedrooms _jA!t- Number of baths Trailer. Court E] Motel L] Other E] <br /> Lot size <br /> Wafer Supply: Public system El Community system F] Private Depth to Water Table _f.. ft. ............................ <br /> Character of soil Lb <br /> to a depth of 3 felf: Sand El Gravel 0 Sandy Loam W Clay Loam Ej Clay D Adobe El Hardpan ❑ r--z <br /> I <br /> Previous Application Made: (If yes,date---------- No OF New Construction: Yes El No 0 FHA/VA: Yes [] No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS ❑ <br /> - <br /> (No-sepficfank-orcesspcol.,permiffed i <br /> a . —.U�aLib�rjcsewer:.is wtaila6le within 200 feet.) <br /> Septic Tank: Distance from nearest well--d--jP -----Distance from foundation_W <br /> No. •of compartmenfs­�'.----------- ----------Material-60----- ---------- <br /> ....... ---Liquid depth....tr._*......I-------Ca pa c;fy. <br /> Disposal Field- Distance from nearest welf_, Q--f.--.-D;sfance from foundation---/ <br /> -ja Distance to nearest lot line-A.Q*' <br /> Nurnber of I nes......I­ I--------------- Length of each line..... ------------------*W;dfh of french ------- <br /> Type of filter maierialW, <br /> --- ----------- <br /> -------------Depth of filter material..../-?-------------Total lengfh./4.p__, <br /> Seepage Pit: Distance to nearest well......................Distance from foundation....................Distance to nearest lot line...._...__.__..._11 Number •of pits.A-------_-----..Lining material----------------------Size: Diameter-------_--- Depth__Cesspool: IP ........ <br /> -I Distance from nearest well.................Distance from foundation...... _----------Lining material._...__._...__......___.._._ <br /> r Size: Diameter----.! ----­Liquid Capacity........ ..... <br /> ......Depth---------------------------------------------- <br /> --------------------------- <br /> Privy: Distance from nearest well................... ..._--- <br /> --------gals. <br /> ❑ a ..............................Distance from nearest buildin ... .......--------...... ........ <br /> Disfance'to nearest lot line-----------_ g ... <br /> Remodeling and/or repairing (clescril):....................... <br /> ...............................................................I <br /> .................................................----------- ---------------......................------------------------.......... <br /> ............................................................ ------...................... ------------------------............................................................ .....................­_­­......... <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 Sari Joaquin Local Health District. <br /> -----------I <br /> By:-- (Owner and/or Contractor <br /> (Signed)_------- <br /> ----------------- ------------------------------------------ --------- <br /> ...................... <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_ F-------I------------------------------------------------ DATE- <br /> REVIE.W....E..D....B--Y---- -- ................................I. --- - *--------D---A---T--EBUILDING PERMIT ISSUED----------------. . ­ -------------------------------. DATE_-- <br /> .-.---...-•------•-----------.-....-..-..-..-..-..-Alterations and/or recommendafions:,.."............... ........-..-..­......-.. <br /> -.-.-.-.-.-.-.-.-.-.-.-.-.-.-............... <br /> ............... <br /> ..................... <br /> ....................... .................... .. ........... .i......................................-------------------­-----------------------..................... .............................----------- <br /> -------------­----•--- •.............. ................................................................ ---------- ......................................... <br /> .....................................................I-------------I.­.................................................................I............... .................................................................... <br /> ....................................___.............­....... ....................... .................................. ........................................­........................... ............ <br /> FINAL INSPECTION BY:.-49 <br /> --- Date_. 17 ol G-- ------ ... ------- ................... ......... ...­­................. <br /> 1601 E.Hazeltan Ave. SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 300 West Oak Street <br /> 124 Sycamore Street <br /> Stockton,California Lodi,California Manteca,California 205 West 9th Street <br /> F.P.0 12. Tracy,California <br />