Laserfiche WebLink
i FOROFFICE USE: <br /> ---------------------------_ -------------- APPLICATION FOR SANITATION PERMIT Permit No. <br /> �{ <br /> ------- ------------------------------------------------- <br /> (Complete in Duplicate) <br /> . _ __ <br /> � Date Issued <br /> ___________ _________._.------__---_---I---------------- This Permit Ex Tres 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 /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION._-- ±�-- <br /> 0 ner's Name____llt �-- <br /> / <br /> '11. <br /> --------•--- ------ ------- --------- ----------------------------------- Phone--------•--•------------•-------•--- <br /> Address----- ------ ------------------------------------ ------------------------------•- -------------•-- --- <br /> Contractor's Name--X-Vol? fir-----------•----------•---- ----------------------- -------------------------------------------------------------- Phone----------•---- -------- --------- <br /> Inaltallation will serve: Residence �j Apartment)House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -1----- Number of b)eo rooms . -___ Number of baths -1---- Lot size __-..._______ _ <br /> - ------------------------------------- <br /> Water Supply. Publics stern Communit system Private Depth to Water Table/_ ft. <br /> pP Y� Y ❑ Y �Y ❑ P <br /> Character of soil to a depth of 3 feet: Sand ❑ 'Gravel ❑ Sandy Loam ❑ Clay Loam4E Clay ❑ Adobe❑ Hardpan <br /> Pre1vious Application Made: (If yes,date--------------------) No E] New Construction: Yes ❑ No E] FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if t lic sewer is available within 200 feet.) <br /> Septic Tank: Distarce frorn nearest well---Y----------Distance from foundation--------------------Material-----------_---.__-__-----___----..--,...______. <br /> ❑ No. of compartments---------J=---=-•_Size--•---------------------- ------Liquid depth-------------------------Capacity-•------------------- <br /> Displ Field: Distance from nearest wellDistance from foundation/d-------------Distance to-nearest lot line__________..__. <br /> JLP <br /> ' <br /> Number of lines---- -•----------------------- Length of each line....... <br /> of trench- ------------------------- <br /> Type of filter material.-A_l' ---�I Depth of filter material-14N------._._Total length__7,--------- <br /> Se page <br /> Seepage Pit: Distance to nearest well--/M----------- from oundation___,_P--_-_-.-.-.Distance to nearest lot line_---------- <br /> iA <br /> } s] Number of pifs-----/---------------Lining material ---------Size: Diameter-_..- De to <br /> Cesspool: Distance from nearest well._____._- Distance from foundation------------------- Lining material -.-.__...._.---------__.__---_._._.fl <br /> �❑ Size: <br /> I ♦ Diameter--------------------------------------De th------------------------------------ --------------Luid,+ Capacity---------------------- <br /> -----gals. <br /> Privy: Distance from nearest well.._______________--------------__--------------Distance from nearest bu lding.-.._____._________._____.-_-_-_-__-__... <br /> Distance to nearest lot line <br /> �,,�f---------------------------------- --- ----------------•-•-------- �----- � I <br /> Remodeling and/or repairing (describe):---Ap5;t ee'''I .-- '- <br /> q� ---------------------------------------------------------- 1r I <br /> ------------------------------------------------- <br /> --------------------------------------------------- --------------- ;--- ---------------------------------- <br /> ,�{-------------------------------------------------------------- ----------------------•----------------------------------------------------------------------------------------------------------------------------- <br /> I hereby certify that lave prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances a e laws, and rules and re cations of the San Joaquin Local Health District. <br /> 1 <br /> (Signed)_______- -------------------..___------- ---------(Owner and/or Contractor) ! <br /> --- -- <br /> I <br /> By----------------------------• -------------.----------------------------------------------------------------------------------(Title).-............._.. i <br /> (plot plan, sh wing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> —FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY__ aa <br /> REVIEWEDBY------------------------------------ ----------------------------------------------------------------------------------------- DATE <br /> BUILDING PERMIT ISSUED-------------------------------------------------------------- ---------------------. DA-TE----- ------------------------ <br /> Alt'erations and/or recommendations:_-_-_-............... <br /> ----------------------- <br /> -------------------------------------------- <br /> ---------------------------------------------------------------- ----------------------------- ------------------------------------------------------------------------------------------------------------------- <br /> ---------- - --------------------------------- --------- <br /> ---------------------------------------------------------------------------------- <br /> ----------------------- ---- ---- ----------------------------- .-- . <br /> - - - - ---------------------------=------------------------------------------------------------ -- <br /> ---------------- ---------------- --- ---------------- ------ ------------ <br /> FINAL INSPECTION BY ------- <br /> -------- -- ----------- -- ----- -- --- ---------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street <br /> Stockton,California Lodi,California Manteca,California Tracy, California + <br /> F.P.C C. <br />