Laserfiche WebLink
FOR OFFICE USE: <br /> = .r-------------- <br /> APPLICATION FOR -SANITATION PERMIT Permit No. ....L',1�.� ... <br />------- --- --1i---------------------------------------- (Complete in Duplicate) bate issued <br /> Ili <br /> This Permit Expires 1 Year From 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. 1 <br /> This application is made in compliance with County Ordinance No. 549. t <br /> -- -- - - _ = <br /> JOB�ADDRESS AND LOCATION-__-__..-_`� ___�K- -------- - �- ----------------- ------- <br /> II , � - <br /> Owner s Name-------------------89AI � '�---l7-Ild'aw---- Phone----------------------------------- <br /> Addr'ess------------------------------------------- <br /> �r�.t ? 6t T/ ----------------------------------------------------------------------------------------------------------------------- . <br /> Contractor's Name----~ /" � ~` �^=' /� � ------------- --------•----------------------- Phone.__ �a-'. � g <br /> Installation will serve: Residence ER"Apartment House ElCommercial E] Trailer Court ❑ Motel ❑ Other <br /> a -- ❑ <br /> 11 Number of living units: _ - Number of bedrooms _ _ Number of baths - _ Lot size .-------- -- ----------------------------------------------- <br /> P <br /> Water Supply: Public system ❑ Community system El �l vth Private e to Water Table99- ft. <br /> is <br /> Character of soil to a depth of 3 feet: Sand E] Gravel San Loam [I Clay Loam El Clay ❑ Adobe Hardpan R_­'i <br /> Previous Application Made: (If yes,date.--.--_------.-----f No New Construction: Yes to ❑ FNA/VA: Yes E] No ®� <br /> k? <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> 11 (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 /> 9A_hNo. of compartments----- -------------------Size------•-------------------------Liquid dept'--------------------------Capacity-•--------------------- <br /> Disposal Field: Distance from nearest well--- Distance from foundation------/0'i-.-Distance to nearest lot lin -- . <br /> � � Number of lines--------------I-.--.-_----�_ -_.aa_��L,��ength of each line----------�!--.-----.Width of trench.------- - <br /> : of filter material- e, of filter material---------/-t�,�-------__.Total length_-.----- ------------------ <br /> -Type --- <br /> +says-� .' ' <br /> Seepage / Distance to nearest well_..--AT!-------Distance om foundation-----1�--- `_.Dist ce i o nearest lot lin -.-_----�.-. <br /> �4_ .- - Size: §er.1- �� Depth--------- ---------------- <br /> Number of pits---------I------------Lining material-- - - _ f� <br /> Cesspool: Distance from nearest well-----------------Distance from foundation-__.-_- Lining materia!___-------- _-__-- -_ <br /> El' Size: Diameter---------------- --------------------Depth---------------- ------------ ---------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ <br /> a <br /> Distance to nearest lot line---------------------------- --------------------------------------------------------------------------------------------------- <br /> P <br /> i� <br /> Remodeling and/or repairing{describe}-------------------- --------------------•--•---- -------------------------------------------------- <br /> II <br /> I- � -------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ordPnanby certify <br /> fy and dh ave prepared this application and that the work will be done in accordance with San Joaquin County hereby <br /> Y <br /> ate <br /> les and regulations of the San Joaquin Local Health District. <br /> (sighed) ----- - -------------------- -- ---------------- ---------------- -------(Owner and/or Contractor) <br /> gyrifle , <br /> - ---------------------------------------- ------------------------ - - <br /> (Plot plan, showing size of lot, location of system in ation to wells, buildings, etc., can be placed on reverse side). <br /> i, <br /> �� FOR i EPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY --------- - '------- ---------------------------------- DATE ---- <br /> REVIEWED B7 <br /> Y .... DATE <br /> BUILDING PERMIT ISSUED------------ ----------------- ---------------- bA' - <br /> --------------------------------------- <br /> Alterations and/or recommendations--------------- ------------------- - ---------------------------------------------------------------------- <br /> - - , <br /> I - `- .------------- ; ___ - _ ­ <br /> �..----- <br /> -------I----------- ------ -------- --- -------- - ----------------------- - ----------------- ------- ------------ -- -------- ------- -------------------------------------- ------------------------------------ <br /> FINAL INSPECTION BY:------ - -- - -------------------------------------r <br /> �i 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 /> x <br /> F.P.0 C. r-- - <br />