Laserfiche WebLink
--- ? <br /> ---------------- ----_.---.--.--:.---.-..-.----_- --- APPLICATION FOR SANITATION PERMIT °� Permit No. <br /> ------ --------------------------------------------- (Complete in Duplicate) <br />-------- - ------ -- ---- -�-- �-:_-., .�,. This Permit Expires 1 Year From Date Issued <br /> Date Issued ._... ..:...�. .. <br /> Application is hereby made to tkfe San Joaquin Local Healfh District for a permit to construct and install the work herein described. <br /> This application i made in comRlia�lce with County Ordinance No. 549. ��3 �qp -OS <br /> 103 <br /> JOB ADDRESS AND LOCATI0=_ -1r- ,� _- - S .-.. �`'z-_-:..... <br /> ........................................ <br /> "++r df-1 <br /> Owner's Name-------------------- �'"-' -...,_ -_ -- <br /> c7 Phone <br /> Address........................ fr �.�K----- c� s-�3 -n----- ----------- ------------------------------------------------­_­............. i <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 _--__3_ Number of baths .--2�- Lot size -!�-------------------- <br /> Water Supply: Public system ❑ Community system ❑ Private © Depth To Water Table Y-0 ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam 0 Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: (If yes dote- — _,/ No E] New Construction: Yes,® No [3FHA/VA: Yes E] No <br /> TYPE OF INSTALLATION AND SPECIFICAT NS: <br /> (No septic tank or cesspool permitted if public sewer.is available within 200 feet.) <br /> Septic T n :yistance from nearest well-------... ...._Distance from foundation--------------------Material------------------------------------------------ <br /> - <br /> ] /I f7 I<lo compartments------------ -- ------Size----- --------------------------Liquid depth--_-------------------- Capacity....................... p <br /> DisoQsal Field• b}•�tante from nearest well__ U_Distance from foundation......,. _e--.Distance to nearest lot line.......: ..a <br /> l f �� umber of lines--------------- ----------------Length of each line----__-----��--G'_----.Width�of trench----_------_ �--..-----_-- <br /> t Type of filter material._. i _� Depth of filter material-.,� _._ " Total length................. P-..`..--._ <br /> Seepage Pit: ., Distance to nearest well,_-- --Distance'from foundation---------------_--.Distance to nearest lot in, --------_--_ <br /> �.: . U <br /> ❑ Number of pits---_----------------Lining.tom matein.al----------.-----------.Size:�Diameter--..-_-_.--------------Dept h--------------------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation......--------------Lining material------------------------------------- <br /> E Size: Diameter-------------------------------- ----Depth--------------------------------------------------.-Liquid Capacity----------------------------gals. <br /> Privy:' w_ Distance from nearest well-------------I--------------------------- _------Distance from nearest building----_---.---_--_----___--___-------------. \ <br /> ❑ Distance to nearest lot line-__.---_ <br /> F -- ---------------------------------------------------------------------------------------------------- <br /> 9 pairing (describe): <br /> Remodelin and or re alnn ------------- ----------- -- ----------- .....................-___....-....... <br /> ......_ <br /> ------------- - ---�.�/- ------- ...�/ ...... ---------------------------------...--------------------------------- <br /> ------------------------------------------------ ► -------------, ------------------------------------------------------------------------------------------------------------------------------------- <br /> ----------------------------------------------------------- ----------------------------------------------------------------------------------------------------------- <br /> 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, qnd es and regulations of the San Joaquin Local Health District. <br /> (Signed).... G-` -----------------------------(Owner and/or Contractor) <br /> By:....................................................... ---------.. ---------------------------------------- ------------ -------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------- 7--------------•-----------•----•---------.. DATE---- r/�� G�'�---------------- <br /> REVIEWEDBY------------------------------------ --------------------------------------------------------------------------------- DATE------ •--------------•------------------------------------- <br /> BUILDING PERMIT ISSUED---------------------------------------- ---------•------ DATE------------------------------------------------------------- <br /> Alterafi qn�Vor recommendations: ------------------- ----- ------ ­----------------.. <br /> ------------ <br /> -------------------------------- ��- -t-�----- -� � .�}-�-- __-------��:._ <br /> ----------------- <br /> --------------- <br /> ------ z `- — <br /> -------------------------------------------------------------------------- ----------•------------------------------------------------------------------------------------------------------•---------------------------- <br /> FINAL INSPECTION BY: �----------------- Date----- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 134 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodl,California Manteca,California Tracy,California <br /> ES 9 REVISED B-59 2M 5-62 ATLAS <br />