Laserfiche WebLink
APPLICATION FOR SANITATION PERMIT <br /> Permit No. ------ <br /> (Complete in Duplicate) Date Issued -------I--I S- -• <br /> A lice#ion is hereby made #o the San <br /> 'Joaquin Local Health District for a permit to construct and ins#all the work herein described. <br /> Pp nce with Coun#y Ordinance No. 544. ' <br /> This application is made in compliance o s <br /> ., .. f► ---------- <br /> JOB ADDRESS AND LOCATION: .tom 4 - -- ---•- f <br /> 1/4------- -- - -------------------- -------- <br /> Owner' <br /> --- _ ho e <br /> s �. <br /> P n �. <br /> � ' <br /> Owner s Name w - <br /> -0 C,6 j i <br /> Address----------------1_ one --------------- <br /> ------------------------------------------------------------------------------ <br /> Contractor's Name---- -------- -----•----}---•--�--- - ------------ - -: Motel Other , _ <br /> 4 Installation will serve: Residence 0 Apartment House ❑ Commercial ❑ Trailer Court ❑ �. <br /> Number of living units, _- -_ Number of bedrooms _ . Number of baths -/--- Lot size <br /> Depth to Water Table _9ff:- �'..__ I <br />' Water Supply: Public system'X Community system ❑ Private ❑ Dep Cla Loam Cla Adobe, Hardpan Cl <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Y 0 y ❑ <br /> FHA/VA-.Yes ❑ No ❑ <br /> i Previous Application Made: Yes N-No ❑ New Construction: Yes ❑ No <br /> I TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (Na septic tank or cesspool permitted if,public sewer is available within 200 feet.) <br /> _ Pt <br /> i Septi Tank• Distance from nearest well---_-----------Distance from foundation Liquid de th ---------- <br /> Material----------Capaci#y.----1---------------- <br /> � � No. of compartments---------- -------- Size - q p <br /> + r <br /> i ____ __ <br /> I <br /> Disposal Field: Distance f{rom�nearest well."�""".�---Distance from foundation----�.-6-----.Width ofnce ttre trench. �=e 5 <br /> c5 Len th of each line--------1__o2_0'-- �--------- <br /> Number of lines ------ g ------._Total len th--=---L-21--a---------- <br /> y� De th of filter material-----/�_, - 9 <br /> Type of filter Dep <br /> p <br /> Linin material-----------------------Sizon --------- Distance to nearest lot line---_------------- <br /> Number of is-- e: Diameter .... - Depth---- <br /> Seepage <br /> Pit: Dis#ante to nearest well-----------=--­_____ Distance from foun ati <br /> g <br /> r ` r <br /> Distance .from nearest well --------------Distance from founda#ion_____.___----------.Lining materia___-------_-------- els. (n <br /> Cesspool: Li quid Capacity 9 -} <br /> ❑ Size: Diameter---- --------------- -----------------Depth------------------------------ ----------------- - q p y----------------- <br /> Distance from nearest building-------------------------------------- f <br /> Privy: Distance from,nearest well--------------------------------- --------------------------------------- <br /> -------------- <br /> Distance <br /> ---"--------"---- - --- _7 <br /> ❑ --------------- <br /> Distance-to-nearest lot ine-_-_-------=-------=---- <br /> r <br /> Remodeling and/or repairing (describe):------------------ --------------------------------------------------------- <br /> --------------- ------------•------------------- --------------- <br /> ------------ <br /> =------------------------------------------------------•----•--------- <br /> ------------- <br /> x _ <br /> = <br /> I hereby certify that l have pr pareduthi ons p lli theon Sand lhat thL call{Heallth beDisnetriin accordance with San Joaquin County <br /> ordinances, State laws, and r ea9 <br /> --------------------=------------ (Owner and/or Contractor) <br /> 5i ned ' - /` '`/� � "------------------ <br /> _..(Own d/o on#r or) } <br /> ( 9 )_ -- ----- ------ -(Title)------------------------=------------------ -- ---------------- <br /> -- - wells, buildings, etc., can be placed an reverse si e- ----------------------------------------- <br /> (Plot plan, showing size of lot, location of system in.relation to . <br /> FOR DEPARTMENT USE ONLY <br /> - DATE------------- � <br /> APPLICATION ACCEPTED BY't DATE_ <br /> ---------------------------------------------- <br /> 1 -- - ------------------------------------ <br /> REVIEWED 8Y_- ---- f DATE <br /> 4 BUILDING PERM IT ISSUED.---- 'l 4---�---:11 �- F-; •--------• ------------------------ <br /> I <br /> Alterations and/or recommenda ions:. ----------- <br /> --•------------------------------- <br /> -------------------- <br /> -------------------------- -------------- - <br /> ------ <br /> -------------------------------- <br /> -------------------------- / -- <br /> r Date----- ------�i---- '�---.:_ -m -�' <br /> FINAL INSPECTION BY: .. _ -- - ---•- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 132 sycamore Street 814 North "C" Street <br /> 130 South American Street 300 West Oak Street Tracy, California <br /> Stockton, California <br /> Lodi, California Manteca, California y <br /> �9-2M , Revised 1.57 F-P.CO- <br />