Laserfiche WebLink
FOR OFFICE USE: , � - <br /> -�—�. -- <br /> --------------------------------------------------------- <br /> _.__-___-_____._____....__________ _____________ APPLICATION FOR SANITATIO MIT Permit No. . <br /> - ------ .�j ` (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 /> Sy..' p•� I <br /> JOB ADDRESS AND LOCATION-r..... . '�--. Pat <br /> Owner's Namel' �.. t P�L' ----- --- --- -------------- Phone . 7 <br /> nZ 7jT- <br /> • . <br /> ............................................ <br /> Address �� - -- <br /> - - - ----- <br /> Contractor's Name--- - ----- --- ----- ------ --------- -------- ----------­--- Phone.4G..(7,F6_ 7....------ <br /> Installation will serve: Residence R Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -1----- Number of bedrooms _'1/_ Number of baths-j.---. Lot size ,IRS <br /> _------------------ <br /> Water Supply: Public system Community system E] Private.' Depth to Water Table Wft <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe a Hardpan ❑ <br /> Previous Application Made: (If yes,date--------_---------- ) No ;K New Construction: Yes ❑ No X FHA/VA: Yes ❑ NO;K <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 /> ❑p C4S'�W6 No. of compartments------------------------Size------------------- -----------Liquid depth--------- ------- ------- Capacity--------------------- <br /> Disposal Field: Distance from nearest well,/W..----Distance from foundation.-,30_-----_-..Distance to nearest lot lige.-SW------- <br /> �q{ Number of lines_C4) Len th of each line_- -__ __ <br /> Y� �` 9 4Q-- rl Width of trench. <br /> i-a-I of filter material-- (!Depth of filter material___.C_6__.-_....__Total length-_-�-._ <br /> Seepage Pit: Q <br /> Distance to nearest well/_16r.-_._._._.Distance om unclation_______ ____ _____Distance to nearest lot line-�Q..--_.. <br /> Number of pits__C1.)----------Lining material------ Size: Diameter_-�.3 Depth-_p ------------------ <br /> 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 /> Remodeling and/or repairing (describe):.--_- ------------- <br /> ---------------------------------- <br /> -- �__• - <br /> -------------------------•---------------------••--------------- -----------------•-----------------•---------------------------------------------•----------------•--------•---•----------------------------------- <br /> I hereby certifythat ve prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, 11114-r les and reg tions of the San Joaquin Local Health District. <br /> (Signed)---------- -•------- 4__" Qs��e <br /> -- ------. _ <br /> -------- - ----- ------------ ------ - (Owner(O rand/or Contractor) <br /> BY: (Title) <br /> -------- <br /> (Plot plan, showing of lot, location of system in relation to wells, buildings, etc., can be pla ed on reverse side). <br /> _., FOA DiPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------------ ----- - ---------- ------------------------- ------ DATE.--- = 'E <br /> - --------------------------- <br /> REVIEWED BY -- -- -- --- ------ - -- - DATE....... <br /> --------------- <br /> BUILDING PERMIT ISSUED----------------------------------=--- - DATE <br /> Alterations and/or r 9T e�dations- - - ------- <br /> c <br /> talln. �=rf �SS�o/�1 �1 "�� t1klGEZ/r -- /) y <br /> �1 yl fi...... S� i S r�/a/.... <br /> ------ 3k _✓.�1'-[Zr�h.r-. . _ <br /> y ! `"� 5 � u f--------- -��- ------- --r< ----- <br /> STS - <br /> FINAL INSPECTION BY:.___ - t — <br /> -- -- -- �--- ---- ---- -� ---------- Date----------��---•=/----�--�----------------------------------------- <br /> N J QUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 600 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 />