Laserfiche WebLink
-'FOR OFFICE USE: Z:07— v S <br />----------------------------------------------------- <br /> ---- — <br /> APPLICATION FOR SANITATION PERMIT Permit No. ..... ................. <br /> (Complete in Duplicate) (�- <br /> -- This Permit Expires l Year From Date Issued Date Issued . .... ___f.. <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct n inssttall ge w�k herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> J08,ADDRESS AND LOCATION s� .I!] x._Rol h S-.. �� �f �i MEi---S.t....-- <br /> Owner's Name-----P11ill;L 5-- -------------------•---------- ==-------: ------•------------------ -----•----•------ Phone....R. <br /> 8b4 w th St Stockton <br /> Address -- ----- -- ------- '� <br /> Contractor's Name---T}3.!~_DA_Y--&--XTGH '...0_e-Pt 0--10rlk--SyC-.------------------ ----...... Phone.HQ...b!naa4l....... <br /> Installation will serve: Residence =Apartment House ❑ Commercial ❑ Trailer Court ❑ ' Motel ❑ Other ❑ <br /> Number of living units: -------- Number of bedrooms _3--_- Number of baths ..-1.. Lot size ......1QQY_X104t....................... <br /> Water Supply: Public system CXCommunity system ❑ Private ❑ Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam MX Clay Loam Clay❑ Adobe❑ Hardpan ❑ <br /> Previous Application-Made:., (If-yes,-date----_._--..---.--a No-E] New Construction: Yes ❑wo ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer Wavailable within 200 feet.) " ` <br /> Or <br /> CC Brick <br /> Septic Tank: .;Disfance from nearest well.Nt�ZI�___.Distance from foundation.....�-_-_-.-..._-M terial..................... ........................... <br /> 6•- -- C _.Li u id de th -0- <br /> -N s.. ... , <br /> o. of compartments.---------2__-__-__-.--Size. q ` p- ______--Capacity-.-..•• <br /> 4 ,..�.. N 10 ryq r <br /> Disposal Field: <br /> Distance from nearest well-.-.9n8_--.Distance from foundation..L�S�_5Dar�ce to nearest lo�l .....-.. <br /> .Number of lines----------2------- ------Length of each line------------ -------------- i t of trench...--.--------.....__-- <br /> � Yp� Se R p it -•-- <br /> T e of filter material be th of filter material-------- length------ --1 5 <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation........------------Distance to nearest lot line---..-_--.__--_ <br /> ❑ Number of pits----------------------Lining material-----------------------Size: Diameter.--....._----------.---Depth.__-.-.------------------------- <br /> 'it <br />!, Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-----------------------------........ V) <br /> ❑ Size Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity...._.........•--:gals. <br /> Privy: Distance from nearest well------------------------------------------------Distance from nearest building--------_--___..'..._._._--_--...._____-. <br /> ❑ Distance to nearest lot line--------------------------------------------------------------------------------------•--------------------------•----••--------------•------- <br /> Remodelingand/or repairing (describe):.------------------------------ --------------------------- ------------------------------------•----•-------•----•-•---................................ <br /> Ir. <br /> -•----•-------------------------------------------•----------•------------ ------ <br /> a <br /> ----------------_------------------------------_-------...............-------------•-------------------------------------:---•--------------•-----------------------...-.... <br /> I hereby certify that I have prepared this application and that the work will a done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Jca 'n Local Heal District. <br /> l (Signed}__The DAY' &_ NIGHT Septic `Tank -Sere _e -------------------------------[fi r Contractor) <br /> + -- ----- ---y Title <br /> By:---------------•------•--•---------------------------------••----------------------------- ----------- ------ -- ••. } <br /> -(Plat plan, showing size-of lot, location-of system in relation to ells, buildings, a .,_canTbe_placed-on_reverse-sidel. ..r,- <br /> FOR DEPARTMENT USE(;NLLY` <br /> APPLICATION ACCEPTED BY--------------------------- •---------------------------- f I--G_.-.- DATE--------- ------------------ <br /> REVIEWEDBY-------------------------------------------- ---------------------------- DATE---------------------------------------------------------'--- <br /> BUILDINGPERMIT ISSUED-------------------------------------- ------------------------------------------------------ --.--- DATE------------------------------------------------------------- <br /> Alterations and/or recommend'ations:----•-----------•--------•--------------- '--------------------=-----•--------------- •-•-----•-•-•--------.----------•------- ------------------------------- <br /> ----------- <br /> ----------------•--•-••--•---- <br /> ------------••----------------------------------------•-----------•------ ------------•--------------------------------------------------------------- -----------------------------------------------•----- <br /> t <br /> ` ..----------------------------------------•- • ---------- --- --- -------------------- ---------------.....----------------••-.-...------------------------------------------ <br /> Il <br /> Date------6-- -_O ---------------------------------FINAL INSP ON 3Y:. SAN <br /> JOAQUIN LOCAL HEALTH DISTRICT <br /> ' 130 South American Street 300 west Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,Callfornia <br /> 3 <br /> i ES 9 REVISED 6.59 2M 6-6[ ATLAB <br /> i <br />