Laserfiche WebLink
FOR OFFICE USE:. v <br /> --- ------ ---- ------- ��� -- �• <br /> --------------, -a---__"__---------------� --------- <br /> APPLICATION FOR SANITATION PERMIT Permit Ido. _ ! <br /> r- ----�=°-a---- {Complete in Duplicate) <br /> ". This Permit Expires 1 Year From Date Issued 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 Count Ordinance No. 4 . <br /> JOB ADDRESS AND LOCATION ---`---------- ----------------- <br /> Owner's Name._ ------- - --J--------------�-----------------•------f---------- --- - ---- <br /> ------------------------ ------ Phone----------------------------------- <br /> Address-----7-------- <br /> ---------------------------------Address-------------- - a <br /> Contractor's Name --------------------- ------ Phone.------------------------ <br /> Installation <br /> •-------------Installation will serve: Residence Rg--Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: I-_- Number of bedrooms g--- Number of baths -�_. Lot size ����,� �_"--"_---.____._____ <br /> Water Supply: Public system ZrISImmunity system ❑ Private ❑ :Depth to Water Table a ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [B�aardpan ❑ <br /> Previous Application Made: (If yes,date....................) No Z__`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 /> Sept.js, TaFtkl t Distance .from nearest well-__-------------Distance from foundation--------------------Material-"".__---------"_-..-----_._--_.______..._.-._.. <br /> AWNo. of compartments--------------------------Size------'__.........'_ -•------_Liquid de th-----------------------: Capacity.-, -- <br /> Disp ssal Field:. Distance from nearest well.................Distance from foundation--------------------Distance to nearest lot line---_--_-_...__--- <br /> / Number of lines-----------------------------------Length of each line------------------------------Width of trench----------------.------------------- Oq <br /> Type of filter material-................ <br /> YP Depth of filter 'Material-----------------------Total length---_------------------------------------ <br /> See <br /> ength ._-________.__:----------•------"-__-- <br /> See a e Pit: Distance to nearest well-___ -" Distance fr fou ation____ �c <br /> pg� - ___ _p______ D stan�P to nearest lot " e.4�__ .__..._ S <br /> L� Number of pits______ ___________Lining material.- Size: Diameter.J --------_DeptW � x-°' <br /> II Cesspool: Distance from nearest well--------------__-Distance from foundation______--------------Lining material---.---------------------------------- <br /> ! ❑_ _ Size: Diameter--------------------------------------Depth- `---------- --------------------- -------------Liquid Capacity-- ------------------------gals. <br /> I' Privy: Distance from nearest well---------------------------------- --------------Distance from nearest building--------------------------------------- <br /> ❑ a = r . <br /> Distance to nearest lot line,-, - -------------------------------------------- <br /> Remodeling and/or repairing {describe):--------- --------------------------------------------------------------------------- <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 pind regulations f the San Joaquin Local Health District. <br /> (Signed) ------•------------- ----- ---- - - ------------------------------------- -( er Contractor) <br /> BY: ---------- ------ --- --------,r-----(Title)--- -:------- ---- <br /> (Plot plan, showing size of lot, location of system in rel n to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------------- 7-17-------------------------- ----------------------------------------------- DATE------- --------------------------- <br /> REVIEWEDBY------------------------------------------------------------------------------------------------------------------------------ DATE----------------- -------------------------------.---- <br /> BUILDING PERMIT ISSUED----------------------------------------------=- ------- -------------------------------------------- DATE------------------ ----- <br /> Alterationsand/or recommendations------------------------------------------------ -------------------------- ------ ------------------------------------------ ----------------------------- <br /> ---- <br /> ` _-- -- ---1`�` �' ' - ---------------------------- <br /> - ---------------- <br /> -----------------------------"--------.--------------------------------------------.---------------- - -".------.------------------------------------------------------.----------..---------------------------------- <br /> . <br /> ---------------------------------- -- --------- - --------------------------------------------------------------------- -----•---------------------------------------------------------- ---------------- <br /> I FINAL INSPECTION O':.... ......... tEX06011 • <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> �g <br /> 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street -205 Weit'9th Sireet " <br /> I Stocklon,California Lodi,California Manteca,California Tracy,California J <br />[ F.P.E Q. <br /> 1 <br />