Laserfiche WebLink
Metadata
Document management portal powered by Laserfiche WebLink 9 © 1998-2015 Laserfiche. All rights reserved.
F R OFF E SE: <br /> ._-_..`-___.__:= / �b ................ APPLICATION FOR SANITATION PERMIT <br /> Permit No. / <br /> ------------- ------ ------- -------------------------- (Complete in Duplicate) Date Issued ..7:/..L:. <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. I <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND L?Ae, <br /> ATION-------•�°�3_7-1-------�` /4 --------------------------------------------------------------------------------------------•- <br /> Owner's Name----------- e -.- - ----------------------------------- el <br /> --------------- ------ Phone._77e4 <br /> Address-_..---------..... -3Z---•-f:._-- •--- ----- - ••------- --- <br /> ' <br /> Contractor's Name................. E .. Phone.........--_-_------------------- <br /> Installation <br /> _......_----___.Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other 01,- <br /> Number <br /> 1 Number of living units: _"`__ Number of bedrooms ___"___ Number of baths ----T. Lot size ---------k��.��6�?4 <br /> ...... <br /> Water Supply: Public system (Community system ❑ Private ❑ Depth To Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sa y Loam ❑ Clay Loam 0 Clay ❑ Adobe[Hardpan 11Previous Application Made: (If yes,date___________________) No [ New Construction: Yes ❑. No ❑ 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.)�j <br /> Septic nk: Distance from nearest welL___77------Distance-from foundation.._-../LL._..._Material-�__- _� <br /> No. of compartments....r___ ��__.•:--Size_____=y'C- - .- ---Liquid depth------�--�-.-------Capacity..- <br /> Dis osa Field: Distance from nearest we Distance from foundation______-_�____.Distance to nearest lot line__.. <br /> p ------ f ........ <br /> EVNumber of lines________________ __ ____-�___. Length of each line__________ _.Width of trench____... V <br /> Type of filter material. . ____ It Depth of filter material______r_ ._.:_______Total length_.......,��5_� . ,�7.� <br /> . _..... <br /> See Distance to nearest we Dist <br /> pDist a to nearest lo# line__ _Number of pits_______________ _____Lining materi -__-Size: Diameter____----...__Depth------- .......... <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_.______---__._-_____.____.__._._._ <br /> ❑ Size: Diameter--------------------------------------Depth.------------ ---->-------------------------------.-Liquid Capacity---------------------------gals. <br /> Privy: Distance from nearest well_________________________________________ _______Distance from nearest building---_______________________________._--_--- <br /> ❑ Distance to nearest lot line-------------------------------------------- ----------------------------------- -------------------------------------:-------------------- <br /> Remodelingand/or repairing (describe)--------------------------------------------=---------------------------------------------------.--------•--._...----------------------------------------- <br /> ------------------------------------------------------------------------------------------------ <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------•---------•---------------------......---------•------------------- <br /> 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 /> (Signed)--------e_el.� ...... � -------------- - ----------------------------------t----------------------------------------------__._.(Owner and/or Contractor) <br /> By-------------------------------------------------------- (rifle)-------------------------------------------- - -- -------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed an reverse side). <br /> �j- FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------------------ 2-_ ----------------------.--------- -------•--------------- DATE-------7=z�4 ------------------------ <br /> REVIEWEDBY--------------- -•--------•-•-•-------------------------------------------------------------------------------------- _ DATE---------------------------- ---- <br /> -- ------------------------ <br /> BUILDING PERMIT ISSUED..................... DATE.------------------------------------------------------------ <br /> Alterations and/or recommend�ati�o s:----- _ ,� � ,- ------... `=est :........... � —�•• <br /> C C � �_i�-�_l_ rra-f- -� �._ e t _ cr c ---------- <br /> .-- <br /> ----------------- <br /> r_A------ ---------- -- -•--------••----•--------- -----•---•-•- ----------.._...--------------------- <br /> FINAL INSPECTION BY:---------- - r -- -------------------------------- <br /> �W. Date.._... �� '--- <br /> SAN JOAQUIN LOCAL-,HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Srrset 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California ' r Manteca,California Tracy,California <br /> ES 9 REVISED S-59 ZM 5.62 ATLAS <br />