Laserfiche WebLink
.,FPR OFFICE USE: <br /> . � <br /> ... ................................................ APPLICATION FOR SANITATION PERMIT Permi+ No. <br /> ................... .......-.......................... (Complete in Duplicate) <br /> This Permit Expires I Year From Date Issued Date Issued .� _3/-, � <br /> ----------- {� 2 --l$p- ed <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 compliancspwjfh Counijr Ordinance No. 549. <br /> JOB ADDRESS A IOL ATI "" --.. J11._G _...__....... ....._... !!.. <br /> Owner's NameJ---------------------------------- ------- <br /> Address........... <br /> d <br /> Contractor's Name----- -••-----_------------------------------------------------------------------------------------------- Phone.�J��l�__._ <br /> Installation will serve: Residence Apartment House ❑ Commercial [❑ Trailer Court ❑ Motel [❑ Other ❑ <br /> Number of living units: -I.... Number of bedrooms ..X. Number of baths Z. Lot size ----- <br /> Water Supply: Public system ❑ Community system ❑ Private Depth to Water Ta6lgo/nrft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br />+" Previous Application Made: (If yes,date....................l No ❑ New Construction: Yes No ❑ FHA/VA: Yes ❑ No❑ <br /> I TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No.septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> r <br /> Septic Tank: Distance from nearest well_�TD.......Distancq from foundation___3.Q--------Material___, n-Q <br /> d/............ <br /> •E No. of compartments-.___0CL..-.__.__.--A..Sizey��-�.���•Liquid depth......41___ -----------Capacity.jwn?., <br /> Disposal Field: Distance from neare t well..,s0-_._ r <br /> P � -- _ Distaste from foundetton.��._____.Distance to nearest lot line...__..___. <br /> Number of lines.__.._ ___._. Length of each linelA4Y.____/d!J"�idth of trench_...__ '.__. ' <br /> Type of filter material.. - Depth of filter mate rial._._fg"__.__=Total length------,3 �e?............ _••:_.- <br /> Seepage Pit: Distance to nearest well......................Distance from foundation....................Distance to nearest lot line.............Number of pits----------------------Lining material--_-------_--.----._.Size: Diameter----------------.......Depth,._---............................ <br /> Cesspool: Distance from nearest well-----------------Distance-from"fQUnda+;On__._.,..............Lining.material------------------------- <br /> ;_ <br /> s <br /> ❑ Size: Diameter..............••--- Depth............... <br /> ._}.....---...._.-----------_,-.._.Liquid Cap acity...._._.__----------------------------gals. X, <br /> Privy: Distance from nearest well............................................__..Distance'from nearest building _ ._._ <br /> --- <br /> ❑ Distance to nearest lot line. -.-................ ` - -1. <br /> -_---_-----•-------------•---- -----------------............ <br /> Remodeling and/or repairing (describe):............................................. - <br /> r 4` <br /> r ---------•---- 6 <br /> .-- ---••----------- ---------------------------------------------------------------------••...........................------......- :. --- <br /> ------- <br /> --------- --------------------------------------------------------Z----------- <br /> ------ <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 a e laws, alt ides and regulations of the San Joaquin Local Health District. <br /> - <br /> (Signed)-- ......... _1................. .. * •�-...•• -------- ---• -- •-- er and/or Contractor) <br /> ay:.. <br /> ---------------- ... . .......................--(Title)..... ......... H <br /> (Plot plan, showing size of lot, location of system in relation to ells, buildings, etc., can be placed an reverse side), -� <br /> FOR DEPARTMENT USE ONLY e <br /> Q- <br /> APPLICATION ACCEPTED BY-- - <br /> -------------------------- S DATE ,�. ..... . <br /> A..._......•••---...._... <br /> REVIEWED BY.....................................- -------.------------ DATE...._. <br /> --------------------- --------•tY <br /> BUILDING PERMIT ISSUED. -- -• -------• ----------•----.__------------------­-------- <br /> ---------- -- ------------••....._ DATE.... .- . <br /> Alterations and/or recommenda+ions:----:_)u. „t 4 5,,. <br /> ..--•_. --.••--•-...._;.......................•..._._.I....------... ...............__ <br /> .....................I............... <br /> ....... .................. <br /> ......................................••---•--......__..... .................. <br /> .............................. , <br /> ......--•-_.._..._..__......_.......---•--. •........................•.----•-•----.....----• <br /> FINAL INSPECTION BY:__L.-..-- ................................... Date_- !.: <br /> . .. .._-. - -- <br /> ?/ " <br /> SAN JOAQVIN LOCAL HEALTH DISTRICT 1 <br /> 1601 !.Hoselron Ave. 300 Wert Oak Street 144 Sycamore Street 1 <br /> r .-205 West 9th Street <br /> Stockton,California Lodi,Confamia -- -.- lVianwca,California "' TraeY,California <br /> E9 9 REViSEo 13.58 3M 3-•68 r.p•co. - /� <br />