Laserfiche WebLink
Metadata
Document management portal powered by Laserfiche WebLink 9 © 1998-2015 Laserfiche. All rights reserved.
FOR OFFICE USE: s7 t <br /> v ,:�_ t <br /> h - APPLICATION FOR SANITATION PERMIT Permit No. - <br /> --------------------------------------------------------- <br /> --------------- --------- ------------------------------ (Complete in Duplicate) <br /> Date Issued <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 /> JOB ADDRESS AND LOCATION-----------1-°-44--------W---44,4:z,;-i.70JU------------------------------------------- ------------------------- -------------------- <br /> __ <br /> Owner's Name-----------•-'----- �• _iA ----------------- ------ Phone-----•--------------- <br /> Address. . . ---------------------------------- <br /> ------------------------•------------ --------------- <br /> Contractor's Name-------------------- h QA7 ----------------------------- ----------------------- - ------------------------------------------ Phone------- -----------------•-•------- I <br /> Installation will serve: Residence ®Apartment House ❑ Commercial.❑gTrailer Court El Motel [I Other ❑ { <br /> r o1 -11, t <br /> Number of living units: __-_ __ Number of bedrooms _sss.__ Number of baths 5. ___ Lot size -_____-4�_�_-x._1�O----________________________ i <br /> Water Supply: Public system [ Community system ❑ Private ❑ Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand ElGravel ❑ 4 Sandy Loam ElClay Loam-Ef"""Clay ❑ Adobe[Hardpan E] <br /> Previous Application Made: {If yes,date________---------3---) No-W - New-Construction: Yes 0 No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: none <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) �. <br /> 3 <br /> Septic Tank: Distance from nearest well----- --------Distance from foundation------A0-------Material------C81tic.he� C._--_-____.._-___.____. <br /> No. of compartments----------1 --------------Size--------------------------.---•-Liquid depth-------4---------------Capacity-----S 0. <br /> Disposal Field: Distance from nearest well___--=_._..Distance from foundation____ O+-_____.Distance to nearest log line---6....... <br /> Number of iinesiQ _ __ _ ___Length of each line__________-_.__._.Width of trench_____�_�;__________________._ <br /> Type of filter materials-- k <br /> -------------Depth of filter matenaL-__.__jg`.___-_..Total. length---------- �__________________________ \ <br />{ Seepage Pit: Distance to nearest well____`'_________Distance from foundation----�U__ ___-_.Distance to nearest lot line---_ _r_'._ i <br /> Number of pits-1------t------------Lining matenal_flOek---------Size: Diameter-.--3_�A_----------Dept ---------------- <br /> i <br /> Cesspool: Distance from nearest welL________________Disrance from foundation--------------------Lining material_...__._.._.__._____.__.___._____._.-. <br /> ❑ Size: Diameter--- ----------------- ----------------Depth-------------------:-- ----------------------------Liquid Capacity. --------------------gals. <br /> Privy: Distance from nearest well_________________,--------------------------------------------- Distance from nearest building----------------------------------------- <br /> r <br /> ❑ i ---- - - -- `-`p--_ -------------- <br />' Distance to near'est' lot line Y ----------------------------- <br /> Remodeling and/or repairing (describe):--------------.-------- � t <br /> ---- ---- <br /> ----- -------------------------------------- - - <br /> ------------------------------------ -------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> E I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> 9 ordinances, State laws, and rules and.regulations of the San Joaquin Local Health Diitrict. <br /> I y <br /> (Signed)&-------- .l.a►a{-- '�'�---------------------- (Owner and/or Contractor) <br /> By-------- ------------------- --•• ----------------------------------------------------------------------------------------(Title)---'----------------- -------- ----- - .. <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., tan be placed on reverse side). <br /> .,rFOR DEPARTMENT—USE ONLY. = ' <br /> APPLICATIONACCEPTED BY - - - - --------------------------------- ---------------------------------.------------- DATE 'off - ------------------------------ <br /> REVIEWEDBY------------------------ ----------------•----- ----------• ----------------------•-==------------------------------ DATE---•-------------------------------------------------------- <br /> 1 BUILDING PERMIT ISSUED-------- ----------------------------------------------------------------------------- ------------- DATE--------------------------------------------- --------------- <br /> lfer s and/o recommends ions:------, ----------- -- ----------------------------- - <br /> ------------- <br /> f --------------- <br /> ------- ----------- -------- <br /> : , <br /> ----------------- - ---- - <br /> KLy e°r9 1.--Nem-----e e <br /> r�` ---Pow-_"k ---�/ <br /> F1NAt�'INSPECTION BY----------- <br /> --- --- ---- - Date. -------------------------- —----------------------- <br /> i r ©5"AI� QUIN LOCAL HEALTH DISTRICT <br /> 1801 E.Ha:ellon Ave. est Oak Street 124 Sycamore Street 205 West 9th Street <br /> 4n,California Lodi,California Manteca,California Tracy,Cali ornia <br />