Laserfiche WebLink
FOR OFFICE USE: <br /> -------------------------------------- <br /> ----------------- ------- APPLICATION FOR SANITATION PMMIT Permit No. <br /> ------- ----------- - <br /> ---..... 1�----------05-- --------- (Cornple+e-in Duplicate) Date Issued <br /> ------------ ----------I---------------- This Permit Expires I Year FromDateIssued <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 AND LOCATION----------� i----- ........ ------------ --------­------------- <br /> Owner's Name----------------_-------4.r--- <br /> ..... ----_------------------ --------------------------------- ------------- Phone------------------------------------ <br /> Address-------------_-----------6.'j----------t&- ...... ----------------------------------------- <br /> Contractor's Name__ ------------------------------------------------------------------------------------------------------------------ Phone----_- ------------------_-----_ <br /> Installation will serve: Residence _Apartment House [] Commercial [] Trailer Court E] Motel Ej Other El <br /> Number of living units: --- Number of bedrooms 3--- Number of baths.--Z----- Lot size _-_-41;_RjEp,&J;--- ---------------------- <br /> Water Supply: Public system E] Community system [:] Private Z;r"Depth to Water Table ft <br /> Character of soil to a depth of 3 feet- Sand E3--Gravel E] Sandy Loam 0 Clay Loam E] Clay Cj Adobe [] Hardpan 0 <br /> Previous Application Made: (If yes,date---..----------- No Er—INew--Gonstruicti-on: Yes El No L&­FA_A/VA: Yes 9�'� No 2�� <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-----5r-_---Distance from fo4nafio*n-----.16------- --------- <br /> _ No. of No. —------------Size----V V/0 X 'P-6 �ty..Ik_y <br /> - ------ ----- I...Liquid dep�h... Ca ci <br /> Disposal Field: Distance from nearest well---. -----Distance from foundation--------------------Distance to nearest lot line__---..--_-.__--- <br /> Number of lines------------- _------------------Length of each line._------ -------------------Width of trench----------------------------------- LJ <br /> Type of filter material--.-..--- ---------------Depth of filter material-----------------------Total length------------------------------------------ N�1. <br /> Seepage Pit: Distance to nearest well_____. -____Distance from foundation-_-__rV--------- istance to nearest lot <br /> Number of Pits._---- Lining material-*", --- Size: Diameter--- ---Depth... ;;97------------------- <br /> Cesspool: Distance from nearest well-------------_-Distance from foundation___-_._.___-._ -.Lining material-_____________________----_-____-_ <br /> ❑ Size: <br /> aterial-------------- ---------------- <br /> Size: Diameter- -- -------------- ----------------Depth-..--. ------ -----------------------Liquid Capacity----------------------------gals. <br /> • <br /> Privy: Distance from nearest well-.----------------_------------_-------------I--Distance from nearest building--------- --------- --------------------- <br /> ❑ Distance to nearest lot line ------- ----------------------- --------------------------------------------- <br /> Remodeling and/or repairing (describe :-------.RE->---A-Q--------- x T!_ <br /> , - u --------Rc�-a4-...Ra, _DVvr_>-------rh <br /> N K <br /> ..............-----­------------------ - :rlc.......... ------------------------------------------ <br /> - <br /> -------------­- ------------------ --------------- -----------I----------------------------------------------------------- ----------------------------------------------------------------------------------------- --------- <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, Stale <br /> )aws, and rules and regulations of the San Joaquin Local, Health District. <br /> (Signed)" --- - ------------------- ---------------------- --- ----------------------------- --------------------------------(Owner and/or Contractor) <br /> By:---------------7 <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 DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----------7--f3,0=-------------------------------------------------------------------- DATE-----------3-1_�:3-- 6 <br /> -------------a------------------- <br /> REVIEWEDBY----------------------------------------------------- ------------------------------------------------------------------- --- DATE------ ----------------------------- <br /> BUILDING PERMIT ISSUED------------------------------- --------- -------------- -------------------- ---------------------- DATE--------------------------------------------- <br /> Alterations and/or recommendations:------------- ----- --__-------------------- ---------------------------------------------------------------------- --------­---------------- --------- <br /> ------------------------------------I--------------------------------------------------- ----------:--------------------------------------- ---------------------------------------------------------_-------------- <br /> ----------------------- ---------------------------------- -------------- ---- --------------------------------------------------------------------------- ------------------------------- ............................. <br /> ------------------- ------------- -----_-------- - - -- --- ------ ...... <br /> ---- ------------------------------------------------------------------------ <br /> FI-N---A---L----I.N...S..P..E..0.....---------------------- -------R ----- -i--- --------- --- Da-t-e--.----_-------------------_-_3------------2-------5..-.- <br /> .-.-.-..--..-.--.- ---- ---------------------*-------- <br /> ------ <br /> ----------------- <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 />