Laserfiche WebLink
FOR OFFICE USE: ' <br /> ______________________________.____.______._.___.__ _ APPLICATION FOR SANITATION PERMIT Permit No. _.._��cr�� <br /> ------ (Complete-in Duplicate) p <br /> --------------- --1-- - -- -------- - <br /> This Permit Expires 1 Year From Date Issued Date Issued <br /> Applications 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. f <br /> - <br /> JOB ADDRESS AND LOCATION........ltieC�' t5 --- �'/✓ <br /> Owner's Name. 1 I_>_ --------------------------------- --------- ------ Phone.�1-.''`� <br /> Address----- - -- -------------------- --------------------------- ---- --------- -----•-------••... -•------- <br /> - ,Contractors Name--- = = - r Phone. _ f <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: Number of bedrooms _3__- Number of baths-Zn-=Lot size -----A-CR —----___________________ <br /> Water Supply: Public system ❑ Community system ❑ Private [Z Depth to Water Table 10__ ft <br /> Character of soil to a depth of 3 feet- Sand K Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date------_------ _____ ) No �ew Construction: Yes ❑ No 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 /> Septic Tank: Distance from nearest well--------------_Distance from foundation-------------------Material ---.__.-----------..-.___.-_----_-----..___-_.-. <br /> ❑ No. of compartments---------------.------.---Size__---------------- - ---•- -----Liquid depth-------- ------- ------- Capacity------------•-------•-- <br /> Disposal Field: Distance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line----------------- <br /> E] Number of lines__________________________________Length of each line_- -------------------.-------Width oftrench.-.--__-_----___.._...___---__._--_ <br /> Type of filter material-------------------------Depth of filter material_--------------------Total length_.--------.___--____._ ---____-__--__-__-- <br /> Seepage Pit: Distance to nearest well__._,:T`­_-----Distance from foundation...../_4'_.........Distance to nearest lot line_,.",a=_........ <br /> N Number of pits_----/------------Lining material-----Rct+--___ Size: Diameter_6_X..1p-Depth__..__---- ... ___--__._Cesspool: Distance from nearest well ________________Distance from foundation-------.-----.--. _.Lining material-------------.-.._._________-.__--___ <br /> ❑ Size: Diameter- -- ------------- ---.Depth-------- ------- ----------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------------------------------- ...... <br /> ❑ Distance to nearest lot line _._---------------------------------------------------- ---------.-.---------.--•-- <br /> t <br /> Remodeling and/or repairing (describe):_____� --------_j_TAT(_oM_•_--QF_--_x.9.6.f.._�1.Lll __.._._. <br /> .........U vD9K-----a-0j(-----ffDPj.Tn_v_1V_ ---- <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 /> ----------- <br /> 9 )--�!-t� -=.-•' -'- -- ----------------------------------------­----- ---- -- - --- - --------- --(Owner and/or Contractor) <br /> By:. --- <br /> (Title). ---- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPART NT USE ONLY <br /> APPLICATION ACCEPTED BY-------7i._Ik-©_•--_.-------- ------------------------------------------------ DATE--.-----�Q--� - ---------------- ------ <br /> REVIEWEDBY------------------------------------------------------------------------------------------------- ------ -------_------------------------------------------ DATE <br /> BUILDING PERMIT ISSUED------------------------------------------------------------—--------------------------- ---------- DATE----- <br /> Alterations and/or recommendations:------------- -- -------- --------- ------- ------ ------------ ----------------------------------------------------------•-----------------•-------------- <br /> ----------------------- ---------- --------------------------- --------- --------------------------------------------------------------- ----- <br /> A I <br /> FINAL INSP Date 10~. - ----------- -----........ <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 <br /> Tracy,California <br /> E.H.9 2M 1.67 Vanguard Press <br />