Laserfiche WebLink
-- ------------------------------------------ <br /> P*.�LICATION FOR SANITATION PERm T Permit No. . _!p'._fl_ <br /> ----------- --------- - (Complete-in Duplicate) <br /> _ _____._...._-- This Permit Expires 1 Year From Date Issued 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. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS A OCATION_ C J--Cy r ,,i_" - -I-/_X.1L.;9SS' /, �- <br /> ---------'-`'-- ----------------- <br /> Owner's Name- --- - -------- ---- -- ---------- -- Phone.-------------•••:----•--•-•------- <br /> Address---- - ------ ----- -- ---------- -------- -----------------••------------------------ <br /> Contractor's Name... -_... .�-------- ------ . - ----------- - -- - - ------- -- Phone.-- - ----------------...... <br /> �� <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other <br /> Number of living units: _/.. Number of bedrooms 7'--Number of baths._/__ Lot size ___�7d_`.Y/11.G__-_.______ ----------- <br /> Water Supply: Public system [Community system ❑ Private E] Depth to Water Table .. ... _ ft <br /> Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam [Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan p <br /> Previous Application Made: (If yes,date. ) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) + <br /> Septic nk: Distance from nearest we11.10Q. _Distance from foundation-----/U_... Material _ ----_ <br /> No. of compartments..--49---------_.`Size-___�_�rf 1,'* _,Liquid depth._.!_ __.._. Capacity / <br /> Disposal field: Distance from nearest well.._ -,PO-Distance from foundation___/4?_/-_-...Distance to nearest lot Zine___ _.s--_-. <br /> Number of lines ------------eI.- ---------..__Length of each line__ ---8'0.----a-----.Width of trench.._�- _--__._-.---___-_-_-- <br /> Type of filter material----..t _�Z_�._-_.Depth of filter material----.��_______--Total length.___�64___�___________________. <br /> Seepage Pit: Distance to nearest well_-_..... -----_._---_.Distance from foundation___________________ Distance to nearest lot line_.________-_____ <br /> ❑ Number of pits._ --------- _ __Lining material-_...- _._.._ Size: Diameter-----------._--- ---- Depth---------- ------_-------------_- <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 /> El Distance to nearest lot line - --- -- - - -- ------•--------------------------•--------•-•----•----------•------------------•-•-------•------------ <br /> Remodelingand/or repairing (describe)------------------ -------------------- ---------------•--•-----:---------------•---•-••---------------------•-------•-----••----------------------------- <br /> .. <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, (to laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)--- - ---6 -------- - ... . --- - ------------------ ---------- -- --------- -' wae�r and/or Contractor) <br /> -----------••--- ------(Title)------ ---------- ------ <br /> (Plot plan, owing size of lot, location of system - relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------,. -__.._..-. . --- ------ DATE-__ ` _-� " <br /> REVIEWEDBY--------------------------------------------- _---.--- ------------------ -------------------- - --- . .----- -------- DATE---------------------------------------------------------- <br /> BUILDINGPERMIT ISSUED----- -- --------------------------------------------------------------------------_. --- ----- DATE---------------- <br /> Alterations and/or recommendations:..................... -------- ------ ---------------------------- ----------------------- --•---------------------•-•----------•--- <br /> -------------------------------•--•- ---- •-------• ----------..._....._...-------------------- ------__--•-•--•---.......----__-----------...---••---•---•--•----------•---------•---•----•---•-----•-------. <br /> ------------ -------------.-------------- ... ---------....------..__......................................................------------------------------------------------------------------------- <br /> ------•--•-------•---- --------------------------•-•-•------------------ --------•---------------••-••---•---•-------------•-----------------------•----•---•--•---------• •---•------ ---- --•--- <br /> . --------- --.......... ... ....... .... ------------------------------------•------------•----- ....................................................... ------------------------------------ ----------- ---- <br /> FINAL INSPECTION BY:.--- �---- _ -. Date �._v� _ <br /> 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 /> E.H.9 2M 1-67 Vanguard Press <br />