Laserfiche WebLink
_APPLICATION FOR SANITATION i-LAMIT Permit No. -. 4.5- .-v. <br /> (Complete in Duplicate) <br /> Date Issued _.... ...ZLs).. <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 compliance with County Ordinance No. 549. <br /> .......................................... <br /> JOB ADDRESS AND LO TION............ ..Y7 s ------ <br /> !- -.......- �/ - --- ._.... <br /> Owner's Name.. - 'CZ. ------------------------------------------------ <br /> G�%Y.k.4E`��f(/-..------ _......_..--- Phone----- '------------ <br /> Address----- -- _-------------------------------------------------------•-----__ - - -_--_--- <br /> Contractor's Name-----•-•---....-... 610u,.d!!u.....- i....... .... '-----------------_--_-- ------------ Phone/-.Y-...'..A__f! -A_7.. <br /> Installation will serve: Residence Apartment,House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -/.-- Number of bedrooms 3. Number of baths I-.-. Lot size ._1Q0_�yX-/'?5:,,,2„,--_,- ............. <br /> Water Supply: Public system (` Community system ❑ Private ❑ Depth to Water Table S� ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam El Clay ❑ Adobe ❑�lardpan E]Previous Application Made: Yes ❑ Ly <br /> No s Ivew Construction: Yes ❑ No Ep�' <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 �...Distance from foundation.-. ��.�_--....Mat�nal._.�a. .ee._..�q !f.� ......... <br /> [� No. of compartments....__.;2Z----------Size._]r .x-.3..-......_.Liquid depth-----(oo.__...__-_Capacity..YAA... ..� <br /> Disposal Field: Distance from nearest well�.d.7•t,P/Distance from foundation---.. ...� Distance to nearest lot line_--------..'.'... <br /> Number of lines......../-..-_... ..........:Length of each line.:-.... 5........._Width of trench__.�_��... ......__._ <br /> Type of filter ma+erial.�^:.u.l.-o-e�C- Depth of filter matenaL .x./_�........Total length-------_73............ ............... <br /> Seepage Distance to nearest well-e--- _..Distance from fou dation___.`61.-..-.--Distance to nearest -5 <br /> Number of pits...... rial <br /> ._ ------..Lining mate .. .Size: Diameter.__-...j........_.Depth-- <br /> - --Lcv <br /> Cesspool: Distance from nearest well............._-_Distance from foundation......--------------Lining material_.--._------------._...._--..... <br /> ❑ _ Size: Diameter....................._......-.......Depth:.-..............--_---- .Liquid Capacity--------...................gals. <br /> Privy: Distance from nearest well--------------------.............................Distance from nearest building.--_..--_._------.._.-----........ <br /> .... <br /> ❑ Distance to nearest lot line..................................................--.-.---........-....._.-.--------------------------.----------- .. ry <br /> Remodeling and/or repairing (describe):--------------------- ---- '- -"-- \ <br /> _...... ....... .--------•---'--'-----------............ .... ---- ---- - ..... ..........................................-----------...............-..................................... <br /> - - ..._ ..-- ...... ----------- -------------------- ------ ------- ....... - ----------------- ----........................................-...------'-'•-........_... - --------- <br /> I herebycertify that I have prepared this application and fhaf fhe work will be done in accordance with San Joaquin County <br /> Y P d regulations <br /> -i ns Joaquin Local Health District. <br /> (Signed) es. --ta ws ss and fions of the San Owner end/or Contractor) <br /> ........................................... <br /> By- ---- - � �� - �/ . ... zsl/ ._•.......-- ._...(Title)-_--e�[----`----------_----------------- _ <br /> (Plot plan, showing size of lot, location of system in'relation.to'w IIs, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY...._...-- .._.... . ..... .. . ----- -------- -- ----------..... DATE........ <br /> REVIEWEDBY...................................... .... ....._... ..._................ - ------ ---------------------- DATE-'---'-----%---” '-- - ' - <br /> BUILDING PERMIT ISSUED. ._.:...._:._..__._..._.. ., .. .._.._.._... ' — .... .... ............ DATE.......... - -�{� ---- - ---------- <br /> Alterations and/or recommen ati 6 <br /> -----------------..... .......................__..._......_ ................_......_._......... ......._.... - ...----.-.......---- ---- -"---------•-. ----------'•-------'--- - <br /> r � .._...._...... .... . _... S 2 .x..-5.`? <br /> FINAL INSPECTION BY:... --. Date...... ............. ...._........................ <br /> _ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 Soath American Sfreet 300 West Oak Street 132 Sycamore Street 814 North ••C'• Street <br /> Stockton, California Lodi, California Manteca,.California Tracy, California <br /> e <br /> .ns..a.rwoao <br />