Laserfiche WebLink
APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) 9� <br /> Date issued <br /> This Permit Expires 1 Year From 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 AND LOCATION-----------------Wi_I_k_ins,*n---Ma-n•a.r------------Lot--- ------------a-_3 7__ - - - ----- <br /> Owner's Name-----------WO-8-dbri- 9t----FiC-a-1-ty---------------------- --------------------- ----------------------- --- -------------- Phone------------------------------------ <br /> - - <br /> Address----------•------------------------- 1902 Pacific AV e. ------------------------------------ ----------- ---------_.-.-..--------------------------------- <br /> Contractor's Name-----------Re-tio.- Relter------------------------------------------------------------------------------------------------.--- Phone---LiA---5-2-61$------ <br /> Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer' Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ---- Number of bedrooms ------3 Number of baths __1---- Lot size ._.'Z5----X.__135--------------------------------- <br /> Water Supply: Public system ❑ Community system ® Private ❑ Depth to Water Table -.-49 ft_ <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[j Hardpan ❑ <br /> Previous Application Made: Yes4j No [2 New Construction: Yes ® No ❑ FHA/VA-. Yes)] No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well--XX--_--.---Distance from foundation!Q..............Material-------------CG---bri&k..-.--------. <br /> No. of eompartments______________ ----------size-56.--X_-_4©----------Liquid depth--4 ..__..-----------Capacity--$_QQ------------. <br /> Disposal Field: Distance from nearest well-----xx......Distance from foundationIQf--.---------Distance to nearest lot line----5-1__----- <br /> ] Number of lines_____2---------------------------Length of each line-_-----75--2-------____--.Width of trench-----24'-'-._.---------..---_--_- <br /> Type of filter material___---s-O-C.k-_.-_-Depth of filter materiall$R-------------Total length------1-5A-i------------------------- Q <br /> Seepa e Pit: Distance to nearest well----X_x----_------Distance from foundation---1 @_1__.--._...Distance to nearest lot line--5-1---------- <br /> �• Number of pits.-----2-------------Lining material---r-o-e-k---------Size: Diameter.--___--33.. p 25 <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 /> ❑ Distance to nearest lot line------------------------- --- --------------------------------------------------1-.._--------------------------------•----------------------- <br /> Remodeling and/or repairing (describe):--------------------Ree._Sept-i-C----systeG�----------------------------------------------------------------------------------- <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, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed) RQ10 ROOTERSEWER� ] <br /> S _ ._______- --------------------[Owner and/or Contractor <br /> --- ..._ £R ________________________________..__. <br /> (Title). .Owner <br /> (Plot plan, showing size t, locat on of system in relation to Ings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---------------- -- - -- --------------------------------------------- DATE-------------7=/ <br /> REVIEWEDBY-------------------------------------------- ------ --------------------------------------------­. DATE------------------------------------------------------------ <br /> BUILDINGPERMIT ISSUED--------------------------------------------------------------—-------------------------------------- DATE--------------- --------------------------------------------- <br /> Alterationsand/or recommendations:_ ------------------------------- - -------- -----•-------------•----------------------------------•-------------------------------------......... ------ <br /> l - -- - -- ---------------------------•-------------------------------------------------- --------------------------------------------- <br /> / = -- - ---------------- <br /> ----------------------------------------•-----------------------------------------•------------------- <br /> ----------------- ------------------------ -------------------------------- ----- ------------------ ------------------------- -------------- -------------------------- --- ------------------------------------------------ <br /> �� f <br /> FINAL INSPECTION BY-. ------ --------- Date------- /- G Q <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 Wast Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> 1 <br /> ES-9-2M Revised s-'s9 r.P.eo. <br /> Y <br />