Laserfiche WebLink
APPLICATION FOR SANITATION PERMIT P • o. <br /> ` Y (Complete in Duplicate) <br /> Application is Hereby made to the San Joaquin Local Health ❑istrict far a _ Data Issued -J}.-xk _S� <br /> This application is made in compliance wi+h County ordinance Na. S49 permit to consfruO and ins+all the work herein described. <br /> JOB ADDRESS AND LQ TFON'� } <br /> Owner's Name-___•__ <br /> Address-----..—_.. '�.- .. _, �/ Phone..... <br /> Contractors .Name.-•------------ <br /> Installation will will! sacra: Residence -•-•-•- -•--•-�----•-._. Phane._......�..�Y.._. <br /> �partrnenf House 171,�..Commercial ❑ Trailer Court ❑ Motel ❑ Other <br /> Number of living units- 1.. Number of bedrooms�_"N'! nsber of baths . ..._-- ❑ <br /> Wa4er Su Lot size r ._CC-�1.-_ ..�'�._. -....._.. <br /> pply:. Public system ❑ Community system }] Private ❑ Depth to Water Table _.__•___ ft•' <br /> Character of$ol to a depth of 3 feet:- Sand ❑ C ravel ❑ Sandy Loan - - <br /> Previous Applicetivrr Made: Yes � --Clay Loam [] Clay ❑ Adobs[] Hardpan ❑ <br /> ❑ No New Construction_ Yes 9__90 ❑ FHA/VA: Yes *Na ❑ <br /> TYPE Op INSTALLATION AND SPECIFICATIONS: # V] <br /> (No septic tank or"cesapool perriiifted if public sewer is available within 200 feet.) <br /> Septic Tank: Dista nee frons neo est Weil _ Distance f rn for <br /> oundation_....4�._....Mater a! . - d <br /> No, of c8mparfmsnts..-- Sixe.. <br /> — _._Liquid depth_ } Ca aci <br /> Disposld: Distance from nearest li f -"" P }Y ....--_I"3 <br /> � Distance from faundatio e�_._....Disfance to nearest lot li6e...1e <br /> Number of _ Length of each Eine___.. <br /> Type of fiiter material .sl "`�_ Width of trench__....+ <br /> Depth of filter material..... sf <br /> Seepage pit: Distance to nearest wall.. - `---- .......from foundation_.—..•_--- Distance-to nearest lot line... _..._. f <br /> Number of pits__._..•------••___--•lining material__-__'----------_-_-- _ *� <br /> 5ixe: Diamefer_----_•_-__-_-.__•_-Depth•--_-•-_. -_ <br /> Cesspopl; Disfance from --._-- <br /> nearest welL __ Dist-once from fourrcde}ian..,- -_--- <br /> ❑ Size: Diameter•_-.._ _—.._..Lining material_,-._ <br /> -----Death_..:.........--••:.._�------------------- _Liquiol Cap <br /> Priv ...-.._ <br /> ❑Y= Distance from nearest well.: }___-__-_---_-____-_-_-- _-Distance from-nearest huildm acts._�H Y~ els, <br /> Distance-to nearest lot _...,- <br /> ' amodeling and�or repairing <br /> _ -! hereby certif that l have-prepared <br /> .• .� .-.......�. ^� ---------------------------------- - ._ ��. .y _.. _.. -•........-....• <br /> appli <br /> Y erre prepared this ns of the <br /> rt Joaat the work will be dare in aoaordanee wi4h $arr,Joaqutr: County <br /> ordinances, Slate laws, and les and regulations of the art Joaquin Local al}hDstns+- <br /> By------- -------•----.._- - • -- <br /> r Contractor) <br /> f ......._.._•.__ _-------- -----------------------__!}Title] , ?Y. <br /> (Plot plan, showing srse of} oca}ion of system ire relation to wells, buildings, etc., can los placeaver ide1. - <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY.._..._.-____• -••- <br /> REVIEWED BY----... DATE.____._._ <br /> BUtLOINC PERMIT ISSUED____ - --•--- --- -----•-- DAT <br /> ___ -,_ `� " .._�_ DATE_- <br /> ia —�-_ <br /> - -- -_--_#srations and/or revommendai -..- <br /> .............................. <br /> -�...._.__._._._.... .------ •------...._ql �' <br /> -•-•-�__._....._ ....... <br /> .. __ --•�-- _-__ __ ---...w- , <br /> FINAL INSPECTION BY:... ....:_.. <br /> ' Dataf -�s - - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT � } <br /> BO South American 5trVot 300 Wye} Oak 5trart <br /> Stockton, California i32 Syoamora Street. 014 Nwh '•C" S+rsat <br /> Lodi, California <br /> ES-9-2M . Revisaa 1-57 F.P.CQ. msn+aca, Galifereia Tracy, California <br />