Laserfiche WebLink
j FOR OFFICUISE: <br /> .............. . _P. <br /> ---------- APPLICATION FOR SANITATION PERMIT Permit No, <br /> ...............I--------------- (Complete in Duplicate) <br /> .. .............. ........................ .............. This Permit Expires I Date Issued <br /> Ap Year From Date Issued ---------- <br /> plication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descq d. <br /> This application is made in compliance with County Ordinance No. 549. <br /> 0 SIF— ef-0—.?—s <br /> Aeo­ <br /> JOB ADDRESS AND.LOCAJION.,,;4�---/yea <br /> Owner's Name..._-.._.le Ph <br /> �;­a- ---------- <br /> ... ----------%%!............. ------ <br /> ---- ----------- ------ <br /> ...... ondo <br /> Address.......... <br /> ......--—-------............................................................... <br /> Contractor's Name------ <br /> ...2- ----------- ...................................................... Phone................---------- <br /> Installation will serve: Residence @T'lApartment House ........ <br /> Number of living units: / 1 0 Comm6itial El Trailer Court [] Motel [I Other C] <br /> Number of bedrooms J.. Number of baths�--- Lot size,/ <br /> "" <br /> W <br /> Water Supply: Public system E] Community system F] Private 190"bepA to Water Table ft. <br /> Character of soil to a-depth of 3 feet: Sand El Gravel E] Sandy Loam 0 Clay Loarri7o Clay [] Adobe ZK11arcloan D <br /> Previous,Application Made: (if yes,date__..............) No 2�' New Construction: Yes LQ.-t�To 0 FHA/VA: Yes �-No 0 <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.__A�a, -Distance.from foundation <br /> (Re, No. of compartments.. ........ ...... jquid depth.- .............Capacityoo <br /> Disposal Raid: Distance from neares well--- Distance from foundation._,A0 Distance to nearest lot line.. -.." <br /> Number of lines-.__.. Length of each line-ARIV -.-..-.-Width of tree <br /> 00 --------- <br /> Type of filter material- -..-Depth of filter material. Total -A............ <br /> length ;._ <br /> Seepage Pit is ance rgo <br /> Disf6nce to neare well.. ��A -.'D' f f fou2lation R <br /> .e <br /> Number of pits --- ........D ance to nearest lot <br /> __VZ - <br /> --------- .__Lining rriaferial,A51 Size: Diameter,.?. lortw_ -W <br /> - --------De <br /> Cesspool: Distance from nearest well............... <br /> .Distance from foundation-----------___Lining material............---------------_-- <br /> 0 Sizef: Mamete'r.....................................Depth--",,.....................------------_..-------..Liquid Capacity---------................gals. <br /> Privy: Distance from nearest well..-._-----.-___._._ -_.-.---Disiance, from nearest bu;ldin <br /> g......................... <br /> El Distance to nearest lot line.._.- .......-------------------------------------------- I . .... r <br /> - -- ---------------- ------------------------------------- <br /> Remodeling and/or repairing (describe):.......... .. . ........ <br /> ...............................I..........................................___!_..•--•-•--'._...-...._....- <br /> 1------------------------------------- <br /> .......................... -----­-------------...... -- <br /> - ---- __ 2 <br /> -----------_•-•---------------------------------------------•- <br /> ------------------......................----------------..••---•-••........-..-...-•-•------------------ <br /> 1 <br /> ................­­­-------------------I hereby certify that I have prepared this application and that the work w- <br /> ordinances, State laws, an ill be clone in accordance with San Joaquin County <br /> I rules and regulations of the San Joaquin Local Health District. <br /> (Signed------------ ......................................... <br /> =......... <br /> -------------------------------- ------- ..............................(Title <br /> 44�e . - - _ - <br /> (Plot plan, showing size of lot, location of system i elation to wells, buildings, efc., can be paced on reverse sllii:le <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED- BY................................... DATE----.... .. ................... <br /> REVIEWED BY...------------ ........ ............................... <br /> ----------------•--•-------•-------------------•---.---.----.------------------------------- DATE__..... ....---•----------_-•---....•---•-... <br /> BUILDING PERMIT ISSUED............................. ............ I?ATE............... ........................ <br /> ... ............ <br /> Alterations a /or recommendationsY <br /> :.............. " <br /> .....V_V_rv, <br /> ................. ........... <br /> . ........... ........... <br /> -----------------................................................................................ <br /> ...........................................................................---------------­---­----------------------------------- <br /> ......................................I................................._---------------------------------------------------------------- <br /> ............................................................­............................................................-----------L,......................................----­­-----------.............. <br /> ............. <br /> FINAL INSPECTION BY:_.00� Date....... .. .. ........ <br /> ---------- <br /> SAfN0AQ11UIN LOCAL HEALTH DISTRICT - <br /> 1401 E.Hazelton Ave. 300 W st Oak Street 124 Sycamore Street <br /> 205 West 91j,Street <br /> Stockton,California Lodi,California <br /> Manteca,California Tracy,California <br />