Laserfiche WebLink
FOR OFFICE USE: - --------- f <br /> ------ ---- !� i az <br /> ------------ -----_----------------- -- _-_....--------- APPLICATION FQR.—SANITATION PERMIT Permit No. .�.C.�1..�- <br /> ------------- - ----------------------------------- ' (Complete in Duplicate) <br /> --.---- This Permit Expires 1 Year From Date Issued 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. <br /> This application is made in compliance with County Ordinance No. 549, <br /> JOB ADDRESS ANF <br /> - -V <br /> -----------•----------------------------•---------------------------•---------------------- <br /> 1 <br /> IOwner's Name---- --------•--- --------------------•-------------------------- ------------------------ -- Phone------------------------------ - <br /> Address--......... <br /> -- � <br /> - -------------- <br /> Contractor's Name----------- Phone--------•-•___-- <br /> ---•------------------------------------------------ ---- -------------•-------------------- ------------------- <br /> Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _ 'Number of bedrooms _4_ Number of baths _/----- Lot size ---Zr_y___ <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 [] Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [3--Hardpan ❑ <br /> Previous Application Made: (If yes,date--------------------) No � New Construction: Yes Er"'No ❑ FHA/VA: Yes ❑ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic.ank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well------=------Distance from foundation- p-`-__.-------Material... <br /> ---- --------- <br /> No. of compartments------°L----------------Size---3-A-a-x-- ----------- 74----- -------------- <br /> Disposal <br /> _ � Liquid depth__. ' .....__-__.Capacity--�oo- <br /> Disposal Field: Distance from nearest well---- r-....__- .Distance from foundation_--e __'#-------.Distance to nearest lot line--- <br /> Number <br /> _SNumber of lines:-- —-------------------------Length of each line---',-?p------------------Width of trench-----?, 10. <br /> -g-_"'-------------_-' 1 <br /> Type of filter materiaf -a-GA-------- of filter material---t�-.y----_----_Total length----_--912-------------------_______ j <br /> I - )L)Seepage Pit: Distance to nearest well-~---- ---_--Distance from foundation_Z ............Distance to nearest lot line..�__-_�__-._ <br /> a� ------------------ <br /> (� Number of pits_----l---------------Lining material---,-/-_- I-PC.�-_.Size: Diameter_____---.__------------Depth-- � { <br /> Cesspool: Distance from nearest well-----------------Distance from foundation-----.--------------Lining material__.-.-.-__--__------.----.__----_----. <br /> ❑ Size: Diameter---3---------------------- <br /> I ----------- Depth------------------------------------ - - ------Liquid Capacity--.---------- - 9 <br /> Privy:- Distance from nearest well---------------------------------------------____Distance from nearest building.--.--_-___-.-------_ <br /> ❑ Distance to nearest lot line- ---------------- <br /> -__--------- -------------I----------------- r <br /> Remodeling and/or repairing (describe�---------------------------------- ---------------------------------------------------- <br /> 1 ., <br /> ---------------•-----------•----------------------------------:- <br /> ---- --- ------------------------------ <br /> ----------------- I .;. .ri- <br /> ------------------- `cy----•--- a------------ �"ti" <br /> } i �1 d <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 nd rules and regulati ns of the San Joaquin Local Health District. f <br /> (Signed) F <br /> ------------------------- <br /> (Owner and/or Contractor) <br /> BY---------------------------------------------------------------------------------------------------------------------- --------------(Title)-- --------------------- ---------------- ........ <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can'be placed on reverse side). <br /> t <br /> a <br /> ( FOR DEPARTMENT USE ONLY <br /> I <br /> APPLICATION ACCEPTED BY-------- -------------I------- ------------------------------ DATE--------- /�'� <br /> REVIEWED BY 1 ------- DATE----------- <br /> BUILDING-PERM.fT ISSUED------------- '------ --- --- ------ -------- - ------------------------------------------- DATE <br /> Alterations and/or recommendations-.�------------- --- -- ------------ ---------- ------------------------•------------------- <br /> I <br /> --------------- ------- -- -------------------------- ----------------------------------- -------- - --------------------------------- ------------------------------------------------------------------------ <br /> ------------------------- <br /> -------- ------------- ------ - - <br /> - --------------------------- <br /> FINAL INSPECTION BY------------ ---------------------------------- ------------ ' Date. ----- �-- J <br /> - --c"---------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi, California Manteca,California Tracy,California <br />