Laserfiche WebLink
FOROFFICE, USF: <br /> 0 <br /> �— D <br /> -- ------- -- J <br /> ----------- --------- --------------------------- APPLICATION FOR SANITATION PERMIT � rPermit No. ..f.. ....__...._._. <br /> --------------------- ------------------------------- (Complete in Duplicate) &� �[1 f 5 � <br /> --.-- This Permit Expires 1 Year From Date Issued Date Issued .._f.�1. � <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______________".- L/ ------ Q <br /> Owner's Name_____ - - C <br /> t • -•------ 1-�C• ---------------------------------------------- Phone-----------------------•------------ <br /> Address__.------- _A3..... -- �!(Z. �...................................................... <br /> Contractor's Name.. .... ...'�-r--------- --------------------------------------------------•--------­-------------------­-- Phone................................... <br /> Installation will serve: Residence ❑Apartment House ❑ Commercial ❑ Trailer Court ❑ otel ❑ Other ❑ <br /> Number of living units: __-�___ Number of bedrooms .- .. Number of baths ..../.- Lot size ----_ 141(01/ _ <br /> - -- ............................ <br /> Water Supply: Public system qr-community system ❑ Private ❑ Depth to Water Table,57—aft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe� ardpan ❑ <br /> Previous Application Made: .,(If yes,date--------------------) No �ew Construction: Yes �o ❑ 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 /> s <br /> Septi Tank Distance from neat well Diff <br /> reswe ----------------- stance from oundation_---_---____-----.-Material---_-"....-___.----_-......................._... <br /> No. of compartments-•----------------- ----Size---------------------•-•-•--.---Liquid depth--------------------------Capacity----------------------- <br /> Disp al Fiel Distance from nearest well-----------------Distance from foundation....................Distance to nearest lot line---..........:.. <br /> ��� Number of lines-A---------- <br /> -------------------•-Length of each line------•----•--------•---------Width of trench.-•--------•-•----...--•--------... I <br /> Type of filter material-------------------------Depth of filter material-----------------------Total length_---____---..-----..-..._---___----------- r I <br /> Seepage Pit: Distance to nears twell_- ---___Distance from founclation_14?---_.-.--_-.Distance to nearest lot line..-_6-_-_• -.- <br /> ®�. �. R �, <br /> --Number of pits----------------------Lining material.- .- ------Size: Diameter----✓�. .-----------Depth----.--- -=„2----...-------- <br /> Cesspool: Distance from nearest well.................Distanc.e from foundation--- material------------------------------------- <br /> ❑ l <br /> Size: Diameter.--- Depth Liquid Capacity als. <br /> Privy: Distance from nearest well--------------------------------------------------Dista'n'ce from nearest❑ building-----------____-__.--___--_---_--- ------9 <br /> ' . Distance to Weare"st lot line ---=--------------------------------------------=---------------------------•------•--------•---------------------•-•-------------------- <br /> Remodeling and/or repairing (describe):-- -----------•----------------•- ------------•------------------------------------•--•---------•-----•-•---•-------•-----•-------------._....----------- <br /> ----------------------=�A --------------------------___---- __..-.....____.------_-___---.-..-_-__._--._--_-_-------._-....-..___----__-___-----.-_-_.-_-----_-..-_--_..._.--------..-.-.-._-.--__--.--_--------_------- <br /> ------------------------------------------'--'------- I......._.-I---...---------•--•------------------...--..-......--------------.-...-------•--.-.-.-......-.----....--------------.--.-......---------.-----------------...- <br /> ----------------------------------------------------- -----------------------------------------------------------------------------------------------___----_--_-.-_-_---.-__---.-___---_--------------_---.._-----...._... <br /> I hereby certify that ha prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, r es and-r gulations of the San Joaquin Local Health District. <br /> (Signed)......................... ---- -- -- ---- - ------------------•------••-•------------;----------------------------•- ------------------------------------:-(Owner and/or Contractor) <br /> 8.------•---- ----------------------------------------------------------------------------------------------•----(Title)---------- ----------- ------------.. ---.-- ---------.:. <br /> (Plot plan, sh wi size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse sidd). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY_, . =`I �--.. ----------------------------------------------- DATE z---------•----------- <br /> REVIEWEDBY ---------------------------- ---------------------------------------------------- DATE <br /> BUILDING PERMIT ISSUED------- -------= -• <br /> -----------------------•--- •------------------------------------------------------- DATE---------------------------------------------------- <br /> Alterations and/or recommendati ns: ---4 _„---------------------------,_.-• _-__.. _ <br /> --------------------�--------------------- ----------------=-=-------- -------------------------•------------------------------------ v E:_-... <br /> `1 R <br /> ---------------------------------------------------------------� -------------------- - --------------------------------------------------------------.--------------..-------------------......----•-------------------=.-. <br /> FINAL INSPECTION BY:,; <br /> � = --------------- Date.. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 west Oak Street 124 Sycamore Street 203 West 9th Street <br /> Stocklonr California , Lodi,California Manteca,California Tracy,California i <br /> ES 9 REVISED S-S9 $M 9-61 ATLAS <br />