Laserfiche WebLink
l 10RFFi E- l <br /> E r <br /> 4 <br /> APPLICATION- FOR SANITATION PERMIT Permit No. .._,�.��.�� <br /> - 7 -) Y/' 7 <br /> -- --------- ------------------ -------------------------- (Complete in Duplicate) 3 <br /> -----_._..__ This Permit Expires 1 Year From Date Issued Date Issued ___________ <br /> Application is hereby made to the San Joaquin Local Health District for "'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 C ION•--•./;�--1.4-5-� ------- --------------------------------•----------- --------------•--• -- <br /> Owner's Name ... <br /> k - - _ --------••--------•--- Phone... <br /> Address._..• ' ,` ...................................... <br /> Cantractor s will <br /> ? .- Phone-- .. <br /> Installation will serve: Residence A a enf House 13 Commercial ❑ Trailer ourt ❑ Motel Other ❑ <br /> "Number of living units: __/__ Number of bedrooms ---/-r Number of baths ___f: Lot size _.___,�---XYZ--------------............. <br /> Water Supply: Public system M—c—ommunity system ❑ Private ❑ Depth to Water Table <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ 'Sandy Loam ❑ Clay Loam ❑ �Cla�y ❑, Adobe �ardpan ❑ <br /> Previous Application Made: (If yes,date-.-.-_-..--__.-_.) No New Construction: Yes ❑JIVo ❑'�,FHVVA: Yes ❑ No n--- <br /> TYPE OF INSTALLATIOWAND SPECIFICATIONS: <br /> (No septic'tank o�.cesspool-permitted if public sewer is available within 200 feet.) # <br /> Septic.Tank: Distance from nearest well-_rx:~ 'Distance from foundation-,Z1.....--.Material______C—:.e,� ._. <br /> No. of compartments_.�----------------Size_e_-;� ----Liquid depth_ �__r..Capacity....�r ...._. <br /> Disposal Field: Distance from nearest well-_.--�':____Distance from foundation____-- -_.Distance to nearest lot line•___-•-7-o. <br /> Number of lines_________________ Length of each line-------._-L--±__________.Width of trench______ .__ `...--------._______ •� <br /> 'Type of filter material... j?s Vic'.-_Depth of filter material_..-__,f_8'!(-.dotal .length..........`,2�------------ <br /> Seepage <br /> ___-----:Seepage Pit:` Distance to nearest well--2t—e---___-.Dis'fance.from fo dation__. ance to nearest lot line------- ....... <br /> r <br /> ^k; } )Number. of its-___. _ __Linin material_,. -- - -__.Size: Diameter__ �`__s'_.......Depth__ <br /> Cesspool: , Distance from nearest well_________________Distance from foundation-------------------.Lining material____.______-__-_____._-_...._.---_.__ <br /> ❑ Size!4Diameter#---------------------- ----------Depth----------------------------------------------------Liquid Capacity............................gals, <br /> Privy: Distance from nearest well-----------------------------------_-------------Distance from nearest building_____......---..-___._.---..___________-. <br /> ` ❑ Distance to nearest lot line------------------------ -----------------------••----•--•--4---- <br /> Re odeling and/or repairing <br /> - . ------------- <br /> -------------­- <br /> { escri'b.e)yf's ,. <br /> _---_-_.- �-- - : ....�- <br /> R ' <br /> -------- ----------------- --------- <br /> ---------------...... <br /> ------- ---------------------------------•---------------- --------------------- r-- =------------ ---------------------- I——.--.....----•-------•------------------------- <br /> -----------------------------------------=---- .......................... I <br /> - <br /> ------------- <br /> ------ ----------------------------------------------..:_..------•-------------•-----..-.-•-------------------------------- <br /> I I hereby' afi I-have pre abed this ap' ation and #hat the work will be done in accordance with San Joaquin County <br /> ordinances ate , ;and rul o San Joaquin Local Health Districf. <br /> (Signed ------ - --- • ;•------ -- E - ----- ------- -------------- - --------.....----•---....-- ----(Owner and/or Contractor) <br /> By:.-...... ... ... . � !mac �.. .... - -_ _. --�' ---(Ti+leL, ::: <br /> (Plot plan, showing size of lot, locatio system in relation to wells, buildings, etc., can be placed on rover side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-- --------- ---------------------------------------- DATE-----T nir-- !�--------------------------- <br /> REVIEWED <br /> ---------=------------REVIEWED BY- ----------------------------------------------------------I-------------------------------------------------•-•- DATE---------------- - ------ = <br /> BUILDINGPERMIT ISSUED-------------------------------------- -------------------­- ----------------------­- DATE-------•---:--------------------------------z ----------- <br /> AFFerati sad/or recalda+i ns:- <br /> 4 >l <br /> - --------- ------------------- --------o--------------------- ---------- <br /> , � - ---- ------------------•--------•-------- ------------------------------------- <br /> �I`INAL .-INSPECTION BY: -- _' ------ Date----------------- -2-u �-z <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 So„th American Street 300 Weet Oak,Street 144 Sycamore Street 405 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ZES9 REVISED $•59 LwM 3-61 ATLA9 - (� <br /> f F <br /> 1 <br />