Laserfiche WebLink
:1 APPLICATION FO�ANITATION PERMIT Permit No: <br /> � __�f_ d_�--- <br /> (Complete in Duplicate) 7-- r��� <br /> Date Issued __._____._-._______�" <br /> l <br /> Applica+ion is hereby made to the San Joaquin Lo Y► cal Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 544. <br /> { --------•--------•-------- <br /> JOB ADDRESS A LOCATION'__ "#---"- -- -------- <br /> Phone----••------•-----------•----------- <br /> i -'f--------_-------- <br /> Address <br /> ----•--•------•- <br /> Owner s Name--••---•---------•- ----------�:-----••--- <br /> Address-------- -- ----"=------------- ----------•----------------------------------------------•---------- <br /> - --•-----------••-- Phone_ <br /> Contractor's Name_____. '--------''�"e`' -------------- <br /> Installation will serve: Residence ['fApartmenf House [:I Commercial ❑ Trailer Court ❑ Mote! ❑ Other ❑ <br /> ` __ Number of baths __/--_ Lot size .____ �. ---7� -1-------------------- <br /> Number of living units: _�-____ Number of bedrooms _ -_ ff <br /> Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table 'fit: ft. <br /> l y y Adobe Hard an <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ p ❑ <br /> i - <br /> Previous Application Made: Yes ❑ No 0"'­ New Construction: Yes No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank.or cesspool permitted if public sewer is available within 200 feet.) Y <br /> Septic Tan Distance fromnearest well---------------- Distance from foundation_________-______-_.Material_-__-__________-__-----------------------------. <br /> No, of compartments----------------- <br /> Size -----------------------Liquid depth-------------- - ---------Capacity----•- -------------- <br /> Disposal F D. : Distance from nearest well____ __________Distance from foundation---------------- to nearest lot line-__________._..." <br /> , i Number of lines---- ----Length of each line--------- -------------. Width of trench <br /> Type of filter material---------- -------------- <br /> ---- <br /> ---------Depth of filter material-----------,-----------Totagl6Leg 3�,j.---------------------,. � <br /> Seepage it: Distance to nearest well___._ _ _Distance from foundation____ta_,___-__.Distance to nearest lo# line----__________-- <br /> i l __ ,, y �,� _ 1 <br /> Number of pits.-----j---------------Lining ma#erial_.1 ----- -Size: Diameter----_`r1 "-?.-----Depth---- <br /> r �-------------------•- '\ <br /> r j <br /> -.<-,"._ <br /> — h <br /> k Cesspool: Distance from nearest well____________ _17is#ante from foundation-__---___--..____-_".Lining materia--------------------____._____-___--" <br /> -- -Depth---------- ------------------------ -------- " Liquid Capacity =-� ----------------gals.❑ Size: Diameter-------------------=--------- - " <br /> k <br /> } Privy: Distance from nearest well-------------------------------------------------Distance from nearest building---------------------------- <br /> ------------- <br /> nearest lot line------ ----------------------•---------------------------------_------ <br /> ❑ Distance to <br /> 1 ____. - <br /> Remodeling and/or repairing (de scribe):_._.__ ----- <br /> ----------•---•-------------------••------•---------------------------- <br /> ----- --------•--------------------- -------------------•--------- -----•---------------- -----------•------••----------------------------•------------------------------------•---------------••-------•---- <br /> t 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 /> +nra„� '---------------------------- <br /> (Signed) -------------- ------- -- r Contract <br /> (Owner J <br /> and/o or <br /> ------ -•-- ----- ---- . <br /> BY: 't'1' , - A '" ---------------------------------- {Title - - _; <br /> Plot tan, showing size of t, location of system in relation to wells, buildings, etc., can be placed on reverse si el. �. <br /> l ( P - <br /> 1 F R DEPARTMENT U-SE ONLY <br /> APPLICATION ACCEPTED BY--- - -- -------- -- - ------ ---------------- ----------------------------- <br /> DATE------ � j----------------------- <br /> MDATE------ •-----------•------------------•------------------- <br /> - - ------------------------------------------- - <br /> tE------------------------- -------- •---------- <br /> REVIEW <br /> ------------------------- <br /> BUILDING PERMIT ISSUED---.--------------------------- -----" <br /> Alterations and/or recommendations:____-_Q- _- ._-_ - Ft , ---7�")"] -� -_- ________- <br /> -----------------------------•---------------------------- <br /> "------••------••-------- <br /> ------------------------ <br /> ---------------- - ------- <br /> J� <br /> Date-.. "1_ ,' ---. ------------------------------_- <br /> FINAL INSPECTION BY:---- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 300 West Oak Street 132 Sycamore Street 814 North "G" Street <br /> 130 South American Street Tracy, California <br /> Stockton, California Lodi, California Manteca, California Y. <br /> E5-9 145446 ATWOMD / <br />