Laserfiche WebLink
FOR OFFICE USE: <br />--------------------------------------------------------- <br />- <br /> ------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. P�._L 3 . <br /> _ <br />---------------------- -- ------------------ (Complete in Duplicate) Date Issued _rr; <br /> -__./�--:•_G`� ' <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 /> /4his a plication is a e in com lianc with County Ordtinance No. 549. <br /> - D s. ja ct � Vi JOB AQDRESSAND LOCN__.i> C - -- �--- -p �p---e�!'r4�-----N ----- A. S-------------------------- <br /> Owner's Name------------ -------------------------------------------------------------- Phone-_-..---------------•---------..---- , <br /> ID _ I <br /> Address------------------ 7 ` - ......BOX........ --- -•-- -----[� 1_ Q../ -------------------------------.------ <br /> Contractor's Name_A..&TROW __ <br /> -----------------------------�------- ------ Phone <br /> - -- <br /> installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: :-.--- Number of bedrooms---_ Numberlof baths J---- Lot size --------------------------- <br /> Water Supply: Public.system ❑ Community system ❑,, Private Depth to Water Table /T5"ft. <br /> Character of soil to a depth of 3 feet: Sand [Gravel"" Sandy Loam ❑�Clay�Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made:. Ilf.yes,date_____________ ( NoJ21 New Construction. Yes R__5o ❑ FHA/VA: Yes ❑ No [� <br /> .TYPE OF INSTALLATION AND.SPECIFICATIONS:. <br /> (No septic tank or cesspool permitted if public sewer is availableswithin 200 feet.) - <br /> Septic Ta Distance from nearest well---5_0-----_Dis ance from'fou�tion uid th_-Material-.-COlVC �r ----_ __. <br /> SCE No. of compartments-------�- yX x-- - --- q p. -��-2 --------Capacity---�2©_O__ t <br /> Disposal Field: Distance from nearest //well_-�t7...._Distance from foundation_1�_Q___-----.Distance to nearest lot - __._.. <br /> Number of lines_--.__----<.--------........____Length of each line---- Width of french.-------.-----__-.._�i�-----. <br /> Type of filter material-_�0_C�__-_Depth of filter material_-..-/�----------Total length------------ ��-------------- .fl <br /> Seepage Pit: Distance to nearest well!----------------------Distance from foundation------------------.Distance to nearest lot line------ J <br /> ❑ Number of p,ts- -- ---------- - ---Lining material-----------------------Size: Diameter-----------------------Depth.-------------------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-...--____.--------------------------. <br /> 1771 Size: Diameter------ -------------------- --------Depth----------------------------- ----Liquid Capacity i <br /> ---..�-...eLi G p Y------------------------•---gal <br /> Privy: Distance from_nearest well---------------_---------------------------______Distance from nearest building----------.--------__-----------._.---.._. <br /> ❑ Distance to nearest lot line -------------- --- ------- ----------•---------------------- <br /> • t� T � .�_ i 1 <br /> Remodeling and/or repairing (describe)r_..flE_F4}_CI=------ZV�-----�a�/_C------'"��N-tjl---1--�AQ-----TO--------- r <br /> tT�- �— D 1�1. 1 �_-F-a-------------------------------------------- -------------------------------------- ---------------- <br /> ------------------ ----- -r�.0 ------------------------------ <br /> - ---- -------- --------- <br /> I hereby certify that I have prepared this,applicetion and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules end.regulations of'the San'Joaqufn Local Health District. + <br /> {Signed)------4_�-.,-- =�9` � �C . I�elz�l -- — -i ---- (Owner and/or Contractor) t <br /> _- i f` , <br /> Title------ ---­ - ------------- ------------------- -- I <br /> - ------ -------- { ) <br /> (Plot plan, showing size of lot, loaatio sys in relation to wells, <br /> b4uildings, etc., can 6e placed on reverse side). <br /> + r <br /> FOR DEPARTMENT USE ONLY <br /> ,. . <br /> APPLICATION ACCEPTED BY- ---'-----------------------------l------------------------------------- DATE-------- <br /> REVIEWED,BY-a=----;--_:_---- ----- II DATE----- -----------------•------------------------------ <br /> tions and/or recommendations:-- ----- =-----�. -��---------- - -----/_j`9/­ ­­_`0_C11_7_.,- • <br /> Altera <br /> UILDIN PERMIT ISSUED_- -ation w_}= T =w-..�--k,A. 1- 4 ftV------- --------------------------- <br /> ----------------------------- -a4�to - ------------- - - -------- - - --------- <br /> FINAL INSPECTION BY ._ Date-- ---- - . <br /> SAN JOAQUIN LOE."AL-H1+ALTH DISTRICT <br /> 1803 E.Ka:elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> r <br />