Laserfiche WebLink
FOR OFFICE USE: <br /> -------- ---- ----- --- - - ----------- APPLICATION FOR SANITATION PERMIT Permit No. <br /> _ (Complete in Duplicate) D to issued �__?d <br /> -A( 't This Permit Expires 1 Year From Date Issued <br /> -----�_�-. ication ishereby•--------- - --- �c,.j <br /> Application i <br /> p y 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 com li ce with County Ordinance No. 549. <br /> JOB ADDRESS AND LOC ION...._ .'_----� I-Ir I � -..- 4�--11 s t <br /> Owner's NameCL ----------..BA-Ctf--------------------------------------­------------ ---------------- ------------- Ph -----------•------------------------ <br /> Address-----------------R..O - Y- <br /> 0 -- ,��-----------+'Rj---P0A-'----------------------------------------------------•--•-------- <br /> - Phone---------------•------------------- <br /> Contractor s Name--------..19WA(F-- , -L.._..-- k <br /> t <br /> Installation,will serve: Residence ❑ 'Aparlment House ❑ Commercial ❑ Traileriut . Motel ❑ Other ❑ <br /> Number of living units: _�.--__ Number of bedrooms --.umber of baths ---I--- Lot size ------ ------ <br /> Water Supply: Public system [�Comml pity system ❑ Private ❑ Depth to Water Table ft. <br /> Character of soil to a depth of 3 feet: Sand @9"'Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made: (if yes,date-.'-_ .-------------) No [ New Construction. Yes [3 No ❑ FHA/VA: Yes ❑ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is �'vaiiable within 200 feet. __- <br /> 1 € <br /> Septic T nk: Distance from nearest well-.--5!Q-----Distance from foundation- /a--------.Ma �ri L--. -- _.IF_Q.O/P 0P---'--------. <br /> - .-2­---­.,Capacity.­-0-�q-- <br /> No. of compartments-( i� -_- --Size-_�X-��-�Liquid depth___ •- ------ <br /> Disposal Field: Distance from nearestwellj.e---A�Distance from foundation--sS✓_-------Distance to nearest lot line.---_---' <br /> Number of lines-__---..--_ -.---Length of each line-.-__ _-. . Width of trenckl._--..._ ------ --- i <br /> ®� ., ------- <br /> ' <br /> Type of filter material!--)?,Q.C-K__-Depth of filter material----.--� _-_-_..Total length <br /> --------------- <br /> �, L/___-Distance from foundation--- �`s------- . <br /> of its-___/- _--Lining material-j�0�---------Size: Diam[er .I_._.---Depth-----l ______----.- ------ <br /> Number <br /> p ! ! Lining material——-------------------------- <br /> E Cesspool: Distance from nearest;well--__-__--.-----Distance from foundation--- -.--------- Liquid Capacity ---gals. ilk <br /> ❑ Size: Diameter----- - --1--�------- -----------Depth-----------------------------------�------- - --- q p Y----- ------------------ <br /> Priv Distance from rearest�well-_____--._-_--r ------Distance from nearest building.------_ .- -------------------�------ <br /> Y: i <br /> s ❑ <br /> Distance to nearest lot�line-------- - -- ---------- -- i --------------------- --------------- r T <br /> g / repairing (describe):- -- ---- ---- ------------------- --------- <br /> --------------------- - f <br /> ------------- <br /> Remodeling and/or ------------ -------------- ---- -------m -' € `� -- -------- - <br /> ------------------•---------------------------------•---- ----- ------- <br /> _ <br /> (. <br /> f <br /> ----------------------------------- <br /> ----------------------------- l f ------------------------- --- ---- - ------------------------------• ------- F -------------�'�"�' -------------;�---y--:--, --�-- Jac' .• _ <br /> I I <br /> - qy <br /> 1 hereby.certify that I have,prepared this application and that the work will be done in accordance wi+h San Joaquin Count <br /> y� L <br /> ordinances, State laws; and rules and regulations of'+he;San Joaquin Local Health District. <br /> ' ' w" ' I Owner and/or Contractor <br /> (Signed)-------- ------- ..- t �------------------------------------------------------- -------- ( / <br /> - em, relation-+o wells,-buildin s,-etc.,�can`be-placed on-reverse sid <br /> 9 -- Title----- - ----- <br /> ---- -- ---- <br /> --(Plot Ian, showing size of lot, location of syste , 9 ,P.. <br /> FOR DEPARTMENT USE ONLY <br /> �--�- DATE. ------ -7/3- � <br /> r APPLICATION ACCEPTED BY__----.----I- �-__R•0:----- --------------- - - <br /> REVIEWED BY------------- -- - --------- ------- --- ------ ------------ ----- - ------------------------------ --------- ---- <br /> DATE------- --------------------------------------------------- <br /> ------------------------------- ------=------- DATE-_----------- -- <br /> BUILDING-PERMIT ISSUED--------------� ------_"------------_---_-_- ---------_ -_-_—,---------------------- <br /> Alterations and/or recommendatio :------- ----------- ------------------ --- -------- ---------- ----------- ------- <br /> ----------- -------------- ---- <br /> ---- <br /> Pi. ' ` (+� ------ - - i, <br /> FINAL INSP N BY:- Date-----.. <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 /> 1 <br />