Laserfiche WebLink
FOR OFFICE,USF <br /> ""---"-"-- ----- APPLICATION FOR SANITATION PERMIT Permit No. <br /> - -"--------------------._-_--.--------- <br /> .A. ��Complete in Duplicate) Date issued <br /> -_.-- <br /> -- ------------------ ---- ---------- ---. <br /> This Aermit Expires .1 Year From Date Issued <br /> Application is hereby made to the SmJoaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in complian8�with County Ordinance No. 549. <br /> �s +` e, <br /> JOB ADDRESS AND, LOCATION <br /> ;-- ---� ----------- -- - ------------------'- ----��` -- �-+ <br /> Owner's Name___________ <br /> 11--� ' `� .1__1.Q_f�l� 5". '------------------ Phone_ <br /> Address------------------- --`- <br /> _Q __' A_ .---- -a z�----------4A�FRRV P------------------------------------------------------------------------------------------- <br /> Qlr <br /> Contractor's Name_ JP4!FM-----�- -•------------- ----------------------------------- <br /> Phone------ ----•------------•---------- <br /> Installation will serve: Residence ejApartment House F-1 E] Trailer Court E] Motel ❑ Other ❑ <br /> Number of living units: -1----- Number of bedroomsT <br /> _-_ u s-� <br /> ber of bath -- Lot size ---_.}A00-._.}�_p-"f_P _^" <br /> . -----•------•--"----- A <br /> 9 " <br /> Water Sup y:F-Pub-lic system"�ommunity system❑'�Prwa eDept to Water Table lrTfI <br /> Characterlof soil to a depth of 3 feet- Sand ravel ❑ Sandy Loam Clay Loam ❑_ Clay ❑ Adobe ❑ Hardpan ❑ <br /> Eons#.ru.ction:: _Yes-� o<❑ FHA/VA: Yes 2 El <br /> Applica+ion Made. [I yes;date y 1 <br /> TYPE OF.'INSTALLATION AND SPECIFICATIONS:.....— <br /> _ --- Ma <br /> ter a I <br /> (No septic tank or cesspool peer ert}deif lie D of I foundation-�00 feet.) �� " <br /> j_.r. . <br /> Septic T k. 1 Dastance from nearest �0 <br /> 'No, of compartments_-_--2 -._..-..__Size- A2..K�----•Ligeid dep}h----Y/"ter Capacity_._/.��_�__ <br /> = I I � I /� <br /> f 1_ti✓_____---Distance,to nearest lot line................. <br /> Disposal Id: � Distance from nearest well--- _....Distance from foundation_ I r t i <br /> t Number of lines._______--- Length of each line__ __ -.___ �-..-Width of trench._.__-_____----_- -- <br /> t Tyke of filter material__. (7C-, t--Depth of--falter material___-. Total length___-..__ _47-0'------------------ <br /> Seepage Pit: Distance to nearest well_..._.._.:_.....-".._Distance fE0_m foundation--_________________Distance,fo'nearest lot kne__.._._._-__..._ <br /> ❑ € Number of pits- - .. Size: Diameter-- -------------------- Dep}h_ - <br /> Lining material__ <br /> k It V <br /> Cesspool] Distance from nearest well----------------Distance f orn foundation...._.....-..-.. ..Lining material___--" ---__--.-____-_.-_______._.___ <br /> 1 Depth ----- Liquid Capacity... -------------gals. <br /> ❑ :Size: Diameter- .- ------ •---- ----- ------ r� --- - ------ --- - -- <br /> Privy: :Distance from nearest well--------•------------------------------"-------Distance from nearest building--.------- ------------------------- <br /> I ❑ liDistance to nearest lot line ----------- -------. ------------------ F--------------------------------------------- <br /> ------------ <br /> Remodeling and/or repairing [descrilae}:--------"- --- --- ------ •-------- --------------------------------------- ----- L` <br /> ( i( <br /> 'r R jai ----------•• ----------"- ------- -------------------------------------------------•--' <br /> - <br /> ----- <br /> -- -------- <br /> -•---- - • - - E <br /> i` I hereby certify that I fiave.prepared this application and that the work will be done in accordance with Sen Joaquin County <br /> t ordinances, State laws, and ides and regulations of the San Joaquin Local Health District.`! <br /> l <br /> (Signed} ; ,. ----------------------- 3"-"- - ---- - (Owner and/or Contractor) <br /> --- -- <br /> _ - .- (Tiff}"---- - -.. .[---—... <br /> -- <br />�(Plo~t�p-•s <br /> plan.1 showing size of lot, location of system in relation fo wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE UNLY i <br /> . <br /> APPLICATION ACCEPTED BY - �c��-�-----' - i----- ------------ DATE------- - --•----- --------- <br /> ----- <br /> REVIEWEDBY------ ---------------------=----------------- --------------- -------------------------------- ------------------------------ [DATE----------------------------- ------------------------------ <br /> BUILDING PERMIT ISSUED-------- -- - ------------------------- ---------- ----------------------------------------------- D�ATE"'----------------------------!---------- -- ---------------- <br /> i i <br /> _9 ,rT �r _. � <br /> - <br /> - ----------•-- ------•----•- -- - <br /> Al+era#ons and/or recommendations------------------ ---- ------------ <br /> -Y ---------------------- <br /> 1 r 4; 9 <br /> f <br /> -----------------"- --------- <br /> t <br /> j' --- <br /> I <br /> FINAL INSP BY: _ - Date --------------------- <br /> �7 E� - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 20.5 West 9th Street <br /> { <br /> Stockton,California Lodi. California Manteca,California Tracy,California <br /> - , <br /> F E.H.9 2M 1-67 Vanguard Press <br />