Laserfiche WebLink
Metadata
Document management portal powered by Laserfiche WebLink 9 © 1998-2015 Laserfiche. All rights reserved.
ice: <br /> FOR OFFICE USE: "" I <br /> C70 r! Permit No. ../.21� <br /> s... <br /> �- -y- 9`..---._--- APPLICATION FOR SANITATION PERMIT <br /> " L ;� 3r1.y _4`-�- (Complete in.Duplicate) <br /> - — Date Issued .�-�-�----�•-� <br /> ----------- ----------- --------------------- <br /> - :-- -. This Permit Ex "fires 1 Year From Date Issued <br /> d. <br /> Application is hereby made to the San J to Counui ty Health District <br /> for a permit to construct and install the work herein descr e <br /> This application is made in compliance w Y <br /> 1 -------•---------------•-------------------- <br /> -------------- <br /> .JOB ADDRESS ANDLOCATIO . ems--- Phone------------------------------------ <br /> �._ --------- <br /> Owner's Name--- ---------------- <br /> --•---------- ------•--- <br /> 3 5 _-. =g <br /> Address-_.-_•�2___-- one__-----__---••--- <br /> Contractor's Name----LL---•---- Other ❑ <br /> Commercial ❑ Trailer Court- ❑ Motel ❑ <br /> Installation will serve: :Residence 2i�partment House ❑ 1.0 <br /> Number of living units: ---/-_-- Number of bedrooms---- Number of baths--_ of size .__ -- <br /> I Private Depth to Water Table 4t1"ft. <br /> Water Supply: Publicasystem �Commusiity system ❑ ❑ p Clay Loam Clay ❑ Adobe ardpan ❑ <br /> Gravel ❑ Sandy Loam ❑ Y - <br /> ' Character of soil to a depth of 3 feet: Sand ❑ [ New Construction: Yes [n"-'No ❑ FHA/VA: Yes El 'No I-► <br /> Previous Application Made: (if yes,date--_:-----_ <br /> TYPE - 1 No <br /> I <br /> OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank-or cesspool:permitted if public sewer is available within 20U feetr <br /> G <br /> Septic Tank: Distance from`nearest well-----------------Distance fro�m�fotin Liquid depth <br /> .y(Material---- <br /> k _Capacity---- ------- <br /> ` Size P r . <br /> No. of compartments_-----'2- -- e <br /> ot <br /> Disposal Field- Distance from nearest well--- ---. - --DDisaofce freach line om atio4-��_----------..Distance <br /> dth ofttren'che$-?k!-l�----- <br /> Number of lines = LengthTotal length---�CS ----------------------- <br /> Type..of filter material.��_e-fir------Depth of filter materzal_l.- _y------- , <br /> r <br /> Seepage Pit: Distance to nearest. <br /> well _-r=--------Distance .from foundation...1d__---- _-_.Dist=ance to Depth <br /> low-- ------- <br /> Seepage �Q.-� -/ ---Size: Diameter- --- <br /> ❑�" Number of pits-_-------------------Lining materia-_lr <br /> fi <br /> r Distance frominearest well-----------------Distance from foundation'-------------.-----Lining material-----------------------------------•- <br /> Cesspool: } --Liquid Capacity-------------_----------,--gals. <br /> � ❑ Size: Diameter------------ ------ '------ ----------Depth_ ------- ----------------------F------------ <br /> Distance from nearest.building---------------------------------------- <br /> Privy:t Distance from nearest well'- -------------------------------------------- -_---. <br /> ------ ------------------------------------------------------- Q <br /> ❑ - _ _ ,._ <br /> Distance to nearest lot line-_,__.---:------------ ---- ---- ---- - , <br /> i <br /> Remodeling and/or repairing (describe)----------- -- <br /> ---------------------- <br /> ----------------------- <br /> -------------------------- <br /> •----------•--------•--------------- <br /> 1 �i ---•------•--------------------- ---------------------------------------------------------------------- <br /> ------------- ---------------- -------------------------- <br /> ------------------------- <br /> I hereby certify that 1 have`$repa edula s ap application <br /> ation and an Jothat aquin Local Healthe work eDi District. accordance with San Joaquin County <br /> ordinances, State laws, and rules g <br /> ----------- <br /> ----------------------(Owner and/or Contractor) <br /> ----------------------------------------------------- <br /> Sined _ --- ----------- --- ------- -------- <br /> BY - :I -------------------------------------------------------------------- --(r <br /> (Plot plan, showing size of lot, Iodation of system in relation to wells, <br /> buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> )ATE----9`�1------ --- ------------------------------- <br /> APPLICATION ACCEPTED BY --_ a---- - DATE----------------•---------- --- ----------- <br /> REVIEWED BY----- ------------------•-----•-------------- ---- ------------- <br /> - -----------------=- DATE------------------------_.--_-------------------------------- <br /> I <br /> BUILDING PERMIT ISSUED-------.-------• .0 <br /> . s <br /> Alterations and/or recommendation •.---..--_------ <br /> ------- <br /> ------------------------ <br /> ---------------------- <br /> - ----------------- <br /> -------------------•---•---.-.------ ---------- <br /> ------ ---•------------- <br /> ------------------- <br /> ----- ; <br /> Dte- ----- <br /> ,_y_ <br /> . - <br /> FINAL INSPECTION BY ---------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1401 E.Ha:alfon Ave. 300 West Oak Street <br /> 124 Sycamore Street 205 West 9th Street <br /> Lodi,California <br /> Manteca,California Tracy,California <br /> Stockton,California <br /> Y <br /> ES 9 REVISED 8•59 3M 3-•63 f.P.ga. <br />