Laserfiche WebLink
,.� FOR OFFICE UPE <br /> ..__._ ----_!l.-_-----�/;a_____ 1_i APPLICATION FOR SALTATION PERMIT Permit No. ....L. -r <br /> ------- ----- --•------- ­------------------------ (Complete in Duplicate) ' <br /> --- i 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 County Ordinance No. 549. <br /> JOB ADDRESS AND LOCA ION. e � "'�` <br /> Owner's Name________ ._ /`P�- �• `z"`� � -t�� i - z - <br /> ------------------­--- <br /> Address <br /> ------------------ Phorte.... <br /> Address_. �- /i . C(;/ �`�''` - �0 ��-� 051 � V .................................................. <br /> Contractor's Name---------� ' -, --- F - . Phona... <br /> Installation <br /> will serve: Residence ❑ Apartment House ❑ CorfirlSercial ❑ TrailerC� ❑ Motel ❑ Other ❑ <br /> Number of living units: -------- Number of bedrooms -------- Number of baths _f`___ Lot size -------------------------------------------___......... <br /> _____ <br /> Water Supply: Public system ❑ Community system ❑ Private J3­6epth to Water Table ........ ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑# Clay Loam 2--`C-lay ❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: (if yes,date.-------------------) No ❑ New Construction: Yes B'-No ❑ FHA/VA: Yes [] No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public s�wer is available within 200 feet.) <br /> Septic Talk: Distance from nearest well----- Distance from foundation-... -�-t� �2 <br /> p ,.� --------Materiaf...................................Y_....._ <br /> or No. of compartments______________7�.._Size__�X__`I____�`-/:!?Liquid depth_________--------Capacity-4.1X .... <br /> Disposal Field: Distance from nearest well____--1 'd Distance from.foundation...../.C.,...-.Distance to nearest lot line............�.. <br /> Number of lines__________________ ___-.__-Length of each line_.�_�i__?_.C�____.Width of trench--_7-- '�_.._.__.......... <br /> Type of filter material..... __Depth of filter material-----/F-"/-.-.._Total length--------AL-0-_-__ <br /> Seepage Pit: Distance to nearest well-----------_---------_Distance from foundation--------------------Distance to nearest lot line................. <br /> ❑ Number of pits----------------------Lining material-----------I-------.----Size: Diameter-----------------------Depth-------------------•------------- <br /> Cesspool: Distance from nearest well-----------------Distance from.foundation--------------..___.Lining material--__-_________________----------..... <br /> r] Size: Diameter------------ -------------------------Depth------------------- ---------------- --------Liquid Capacity............................gals' <br /> Privy: Distance from nearest well___________________________________________ _Distance from nearest building------------------------------------------ <br /> Cl Distance to nearest lot line----------------- -------------------------------•----------------------..............-•------------...._..._... <br /> Remodeling and/or repairing (describe):---------------------------------------------------------...-----------------•----•--•--•------------.-.._.._-..--•..... •------•_--_•---_- <br /> If <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 San Joaquin Local Health District. <br /> (Signed)--•-•- -,,T ---------•----•-----•-----------------------------------------------•-•--•---•--••-------...-----------------(Owner and/or Contractor] <br /> By:..................... --�------.......----•-•-••---------------------------------------------------•--------(Title)......(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on revers). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-----/!t/--------- 7?' DATE. <br /> REVIEWED BY ------------•-------------•---------------------------------------- DATE---- <br /> BUILDINGPERMIT ISSUED------------------------------------ ----•-••--•-------•---------------------------- DATE-----------. --•---------------------- <br /> Alterations and/or recommendations:—, � 7�� �- <br /> P --- <br /> ------------------ <br /> tel._ ... ......_=Pte ;^_ z <br /> .... t x <br /> �. � -------- <br /> a�C <br /> FINAL INSPECTION BY:.--.. --------- ,Otte- <br /> ./kQUIV LOCAL WLTH DISTRICT <br /> 130 South American Street 300 West Oak Street C— y��� 124 Sycamore Street 205 West 9th Street <br /> I <br /> Stockton,California Lodi,California Manteca,Cofifornia Tracy,California <br /> ES 9 REVISED e•99 pM 8-61 ATLAS <br />