Laserfiche WebLink
FOR OFFICE USE: <br /> ...................................................... .APPLICATION -FOR SANITAT40N PERMIT Permit <br /> ....................................................... (Complete in Duplicate) <br /> ..................... <br /> This Permit Expires I Year-From Date Issued Date Issued <br /> Application is hereby made to thlil'Joaquin Local'Health Districtfora permit to construct and install the work herein described. <br /> This application is made in compliance with Count Occlinance No. 549. rS0 /3 <br /> 7x <br /> JOB ADDRESS AND OCA0N------ - - - - 12L_ <br /> . .................---------------- _ ....6... <br /> .0..7....... <br /> Owner's No 4 ----- PhonaR_. Pt - <br /> Address................." <br /> .1 -W...... .... ____ --- ----M............ ............. .... ...W. <br /> meq/ <br /> Contractor's Name------- ..... ..................... ---------- <br /> .... 1.1.!` . ..-----_-------------------- .......................w-------------- Phone-------.......................... <br /> Installation wig some: Residence C] Apartment House El Commercial ❑ Trailer Court C] Motel ❑ Other M&,�/4GE2+t <br /> A-L <br /> Number of living units: Number of bedrooms ........ Number of baths ---/-. Lot size ..-rl J.KLI.10. Wit.-..._-.......__ <br /> Water Supply: Public system E3 Community system [] Private g�-­Depth to Water Table .4qxft. <br /> Character of soil to a depth of 3 feet: Sand [M Gravel E] Sandy Loam E] -Clay-Loam [] Clky,C) Adobe 0 Hardpan• <br /> W <br /> �E] FHA/VA: Yes E] No U?� <br /> Previous Application Made: Ilf yes,date------ New Construction: Yes 9"? <br /> V <br /> TYPE OF INSTALLATION AND -SOECIOICATIONS: <br /> (No septic tank or cesspool permitted if public-seviiir is available _iAin 200 feet.) <br /> 4 w <br /> Septic Tank: Distance from nearest Distance fro <br /> u <br /> nclation---/17.........Mat tI. _C----------- <br /> .........capacity.....r( <br /> No. of compartments-......Z_._.._...__Size. <br /> Ong.............Liquid depth-- <br /> Disposal Field: Distance from nearest well..��12__ Distance fr&Kf'aundatid/nok��- �_�­Distance to nearest lofline..../.40---- <br /> ---4............. <br /> Number of lines.... /--------------------Length Width of trench.%.� ----- <br /> Type of filter mateeiaL6j/s,&A:_X4epfh of filter�,_t I length 7. <br /> a a- Ofa .... a.._.-_......___--_._-. <br /> Seepage Pit: Distance to nearest well.,30V_------Distance Jrom�foundation 6- <br /> 5____...___.Distance to nearest lo line/AV./ .... <br /> umber of pits---lv..........._Lining material._. . ................Size:. .............W----Size: <br /> < r <br /> Cesspool: Distance from nearest well............ ....Distance from foundation....................Lining material...._.................___........_ ; <br /> Size: Diameter..... ----------- ....".*....�Depth ------------- ---------------- <br /> 4 1 ..............gals", <br /> Peivy: Distance from nearest well----- Distance frA 4*d`re`Sf'67u!Idin'- <br /> El Distance to nearest lot line..........K"; -------- <br /> ...............__.__......Distance---- 9------ ----------------------------- --- <br /> ................ ...........I...................................­­...... ..................----------- <br /> Remodeling and/or repairing (describe):-..... ................ ............. I................................. ...........................­­....... <br /> --------------------......................................2 <br /> ............................ .................................W.......---------------- -------­­.................................. <br /> ................................................... ------ ---------............................. --------------- --------------------­--­W.......... <br /> ....................................... ---------------­-----Www-----------.................. <br /> I herebyherebycertify that I have prepared this application and that-the-work wilbbe done in accordance with San Joaquin Comfy <br /> ordinance", State laws;and rules ajA regulations of the San Joaquin Local Health District.,.X' <br /> J <br /> (Signed)------- ti <br /> ---------i------------------------------------- <br /> By.............................------__...... ......... '�;4 1 k. <br /> �..........--2t...................... .........-------- ...... ........... .......... <br /> (Plot plan, showing size of lot, location of system in re6tion.to Walk, buildings, ate., can be placed on reverse side). <br /> }FOR DEPARTMENT USE ONLY <br /> APPLICATION,ACCEPTED ........................... <br /> REVIEWEDBY.......................................... ..............................-- ---- ..................................... DATE ...... <br /> BUILDING PERMIT ISSUED.........;Z�., ----------------_----_---------- ---------------------- DATE_ka�,.e�-. w ....... <br /> Alterations and/or rectxnmertd01ons:.....t------------------:............. ......... .......... .................................................. <br /> ..............`--_......a..,.•..`.....-..................................................................................11--........................-..................................................... <br /> . ........... ............;............­­­........................................ -----------------..............------------------------ <br /> .-..................................... <br /> --------- - ------ <br /> .................................... <br /> ..............;- ----------------------------------------------------------------------*----------I--- .-.%....... ......... ................ ........................ <br /> &r�001 <br /> FINAL INSPECTION BY:. . . .. ..... ...... Date....... <br /> ........................ ­............................ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Mote It..Ave. 300 West Oak Street 11 124 Sycan,...street 205 We"911,street <br /> Stockton,California Lodi,California Manteca,Collfrala Tracy,California <br /> -It <br />