Laserfiche WebLink
FOR OFFICE USE, <br /> a, r f APPLICATION FOR- SANITATION PERMIT Permit No. __ • <br /> = - --------- ------------------------ ----------- <br /> (Complete-in Duplicate) pate issued <br /> ---------- This Permit Expires 1 .Year From Date Issued !�,Z--OSS —p? <br /> hereby made to the San Joaquin Local Health District for a permit to construct and install the work herei described. <br /> is he 9 <br /> Application <br /> Y <br /> This application is made in compliance with County Ordinance No. 549. <br /> �{ <br /> kOBQDRESSN ` �� � �ola­�V-oNr--JA � 71 � .fir A !l -� /. Phone._... <br /> Owner's Name------ <br /> I Address------------- ,._ - �-. 'ham+---------- <br /> ,,,}}} , <br /> ----------------------------------------- <br /> Ife-� ',.�+c�� ------ Phone----------••---------------- <br /> Contractors Name ------ - -------------- - ------- --�---- ---------- ------------- - <br /> Installation will serve: Residence Apartment House ❑I Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> (Number of living units: _/.. Number of bedrooms P"- Number of baths-A'- Lot size ,> Gr" + '`------------------------------------ <br /> Water Supply: Public system ElCommunity system [IPrivate YRO'5epth to Water Table/AP-ft <br /> Character of soil to a depth of 3 feet- Sand F] Gravel ❑ Sandy Loam (Clay Loam ❑ Clay ❑ Adobe [3 Hardpan ❑ <br /> I <br /> Previous Application Made: [if yes,date----__--..__..--- 1 No New Construction: Yes S@00no ❑ 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.) <br /> I Septic.T nk: Distance from nearest welL..ee-— Distance from foundation__ev-----____.Material � --------------- <br /> ���... iquid depth �- --- ---.Capacity- p------ <br /> r.. <br /> No. of compartments...... . ..............Size_ ____.__.__ ��- <br /> I Distance from foundationoa........Distance to nearest lot line��- - <br /> Dispasai Field: Distance from nearest well-��-__ � <br /> Number of lines __.----�^ --__ __ ength of each line_.__ ------ry---.Width of trench _---;-------------------- I <br /> __Total len th_ ._. <br /> i <br /> Type of filter material �j1 epth of filter material____/ ..__-- g �----- ---------------- -- <br /> -� <br /> Seepage Pit: Distance to nearest well------- -----------Distance from foundation____-._________.Distance <br /> to nearest lot line----------------- <br /> 4 ❑ Number of pits--- ------------- -- Lining material------------- ------ Size: Diameter---------- ------- -_Depth <br /> Cesspool: DistSized D amete nce from nearest well E-------------- <br /> ------- . .--DDep}inc- from foundation-------=----------- Guild Capacity_.--_.______ -------------gals. \' <br /> l -------- <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-------._____-..____.__---__.___-.-____--. <br /> ❑ Distance to nearest lot line' ---------- - -------------- ---------------------------------------------------------------- <br /> e)---------. -i-_t�iW-.---r+ j�� GP�__ }�ft'� ---------------•-------- <br /> Remodeling and/or repaiting..(describ1. ------- ---------------------- ------------:----------------- <br /> 1---------------------------------------------------------------------------------- <br /> t , <br /> IN <br /> ------ <br /> = - <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) � !" G(--- - ---- ------- ............. ---------------- ----- --------( Contractor) <br /> { ----r-------------------{Title) -A- ---- ------..----- <br /> By:-----------------------------------•------------- ------ <br /> (Plot plan, showing 'size of lot, location of em in relation to we s; •buildings, etc., ca� be placed'on reverse side). <br /> FOR DEPARTMENT USE ONLY.a-.,._.._..) <br /> APPLICATION ACCEPTED BY.___ --------- DATE___-. �_ .._� - --- <br /> - - ----------- -------- ------ ------------------------- <br /> REVIEWEDBY----- ------------- ----- DATE--------- i--- -------•------------------------------------ <br /> BUILDINGPERMIT ISSUED---------- ----- •--------------------------------------- DA-TE--------- --------------------------------------------------- <br /> Alterations and/or recommendations--------------------------- - ---------------------------- ------------ ----------------- <br /> ---------------------------------------------------------------- <br /> ------------• ---------------- ------------ <br /> ------ ------- ----------------------------:------------------•----------------------- ----.------------------- ------------- <br /> FINAL INSPECTION BY:_. - Date-_..1�' _ -----f�--------- <br /> .° SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street W 205'Wesf..91h'Street <br /> Stockton,California 1.90. California Manteca,California Tracy,California <br /> E.H.9 2M 1-67 Vanguard Press <br />