Laserfiche WebLink
FOR OFFICE USE: <br /> —.- APPLICATION FOR SANITATION PERMIT Permit NK <br /> --------=------------- - ------- --- - (Complete•in Duplicate) <br /> �.,.. _ _ . _ Date Issued-----�----------- <br />__..._.____ ----..._._-....____------- --� " 'This-Permif'E;ires I�Ucir From Date Issued " `— <br /> Application is hereby made to the San,Joaquin Local+Healfh District fc,Fa permit to construct and install the work herein described. <br /> This application is made iri compliance with County�Ordinance No. 549. L "� _ <br /> JOB ADDRESS AND LOCATION... 73?-. Et��"--M rNE -- _-moiVE7l7UE---�--------- - -_- <br /> � 1 ,�,,h�, <br /> Owner's Name.-.. I"!L '' F}{�'t-1"lA �'1_LS Phone 4 <br /> ---- <br /> Address------------: .33----- I AZE-� /�V�EJ:--------------- - ------•-------------------------------------- -----------•-------------------------------- <br /> - - _1.... <br /> Contractor's Name--. -� ---- ---- ------ Phone..--•- -----•..--- <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _ ----- Number of bedrooms -------- Number of baths-------- Lot size ----- --- -------- -------- -------------------------------- <br /> Water Supply: Public system ❑ Community system ❑ 'Private ❑­Depth to-Wate7 Table ------ - ft <br /> Character of soil to a depth of 3 feet• Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date-- ....... . .... 1 No ❑ New Constructipn: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: k V <br /> (No septic tank or cesspool permitted if public sewer is available within 200,feet.) W <br /> Septic Tank: Distance from nearest well______ __________Distance from foundation__!_-_ ------- Materiai ---- ---------------- <br /> ❑9cl JAX No. of compartments- ---------------------Size-------------------- -----------Liquid depth--------- ------- --------Capacity----------------------- <br /> � t rl O <br /> Disposal Field: Distance from nearest weli__(a0_- _ Distance from found ation�R.O.--_ .---Distance to nearest lot line. _- <br /> - .1+ <br /> Number of lines __Cl_ .__.. ____ � Length of each line;_._��._.�._._.Width of trench___Zd_F_'__..___.________.__._ <br /> Type of filter material--���� Depth of filter material ` g r1...... Tofal.'.length-------7S-_ .........••---- r <br /> Seepage Pit: Distance to nearest well-- -------------Distance from foundation----.---._.-_--.-.Distance to nearest lot line.-.----------...- <br /> ❑ Number of pits--- ---------- ------ Lining material-----1------'"___-Size: Diameter------------------ ----Depth--------------------------------- <br /> IL <br /> Cesspool: D+stance from nearest well _____....__.__Distance from #oundation................. . Lining materia)-__.._..__._.______-_._____-._-.. <br /> ❑ Size: Diameter- ..........Death ' ' Liquid Capacity-- --------- ------gals. i <br /> - ----------- <br /> Privy: Distance from nearest we]____---_------- _- ......... ....'.-__ ---Distance fr6m'.nearest bwilding.--.-_--...__.--.-._-_-_____-_.-_---.-._. <br /> ❑ -d.-8�4'Y .-'L� rrt � � S <br /> Distance to nearest lot line ----- -- ------ - <br /> Remodeling and/or repairing (describe):........--1. » N -:-�� ----- '�_. _ ` '" <br /> - -------- <br /> ---- <br /> -------------------------------------------------------------------------------------------------------�-----='-----------------------�`---------------------- - <br /> ---- -------- - ----------------- ----------- - ----------------------------------------------------------- ------------------ ---------- ----------------------- ---------------------------------------------------- <br /> 1 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, a ru s and,l-reg lations of the San Joaquin Local Health District. ° <br /> (Signed) r= _= :------- - ---------•-- --------- --------- (Owner and/or Contractor) <br /> By----------------------------- ------- ---- `-- - ------------ ---=-----------------(Title} - ------------- ----- -- <br /> r buildin s, etc., can be lac on reverse side <br /> (Plot plan, showing size of lot, location of system in relation to wells, g p }. <br /> i*,ti r <br /> FOR DEPARTMENT USE ONLY <br /> ACCEPTED i3Y_-- �'------------------------` f ------ ------- - DATE--'/,— <br /> APPLICATIONbr <br /> I -------------t <br /> REVIEWED BY :., DATE <br /> --- ------ ----------- ---- - --- ---- - ----------- ---- ::„. ------- -- - ----- ------------------------ <br /> . x <br /> BUILDING PERMIT ISSUED-------- -- --------------------------------------- ------------------------------. ------ DATE---`--- ---------------------- ---------- ------------------ <br /> Alterations and/or recommendations:_.........................._.-._ '` -- <br /> iz <br /> ------ --------- --------------------------------------------------------- --------------------------- ------------ -- -- - -- - ------------ - ------ <br /> ---------------------- --- -------------------- --------- ------------- ---------------------------------- ---- <br /> L <br /> - -------- - - - <br /> --- ---_____--_-r--------- - ------- ------ --------- ------- -- ------------------------- - - ------- ---- ---------------------- <br /> r <br /> ---------V- --------.-.-.-.-.-.-..--..-.--.-.-._-------------------------------------- <br /> FINAL INSPECTION BY: X------ -- <br /> Date ;...--- <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 /> E.H.9 2M 1-67 Vanguard Press <br />