Laserfiche WebLink
R OFFICE USE: <br /> q_ Ls►-----------------------1-------> <br /> _-------------------------------_----L ;' APPLICATION FOR SANITATION PERMIT Permit No. ..r .��. <br /> ---------------------------------------- - (Complete in Duplicate) <br /> This Permit Expires 1 Year From Date Issued Date Issued __........6 <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 Countyy Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION a _Zz------ --------------------------------------------------- ------------------------------ <br /> I -_ <br /> Name-------� �------ -- •------------------------ ------ --------- --- ------------------------ Phone - <br /> Address----�--�07-- ---- --- <br /> --- / <br /> `Contractor's Name-- e ------ Phone_ <br /> Installation <br /> will serve: Residence [��partment House ❑ Commercial [❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _ __ N mber of bedrooms _ _ Number of baths 1. Lot size ------------------------ <br /> Water <br /> ____ _________________Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table''Y._ ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [❑ Clay ❑ Adobe Jjr<ardpan C] <br /> Previous Application Made: (If yes,date--....--- ..........) No * New Construction: Yes [j�<o ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if ublic sewer is available within 200 feet.) <br /> Septic qnk. Distance from nearest well_________________Distance from foundation__, _____._._.Material-_1.#-----.-_-_--------._____..___�____�._.Q. <br /> C3' - No. of compartments-----�---____-_____Size__J 4 X�_____--___Liquid dep�h---$y..................Capacity__sQd_-- -F"[� <br /> - <br /> e <br /> Disposal Field: Distance from nearest well' .VX.A"_Distance from foundation.__/J___.____.Distance to nearest lot line__________�3__ <br /> Number of lines-.----- ------- - ------__Length of each line_G_S_-GSA-da'-Width of trench____02_ /_------------- <br /> Type of filter material-f5_!__/?-0A_/e_Depth of filter material_- ------Total length---------- "Q_._�_____________._ r <br /> e � <br /> Seepag�it: Distance to nearest wellW -_------Distant om foundation__/A----------Distance to nearest lot line-------- J <br /> 20 Number of pits.__ v - --Lining material- D.S•_/V ..__.Size: Diameter------- -a-,r V) <br /> Cesspool: Distance from nearest well ________________Distance from foundation--------------------Lining material---.--------------------------------- . <br /> ❑ Size: Diameter----- --------------- ----------------Depth---------------- ------- --- -- -----------------Liquid Capacity.---------------------------gals. 0 <br /> Privy: Distance from nearest well-___._.__________________ _______ -- -_Distance from nearest building----------------------------------........ ro <br /> ❑ Distance to nearest lot line----------------------------------------------------------------------- ---------------------------------------------------------------------- <br /> 11 <br /> Remodeling and/or repairing (describe)------------- -------------------------------------------•-------------------------------------- -------------------------------------------------------- <br /> ----------------­--------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------ <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, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> A � � <br /> (Si ned ---------------------------Owner and/or Contractor <br /> 9 -------- --------------- - --- -------------- -----�- - <br /> By:------------ - - �.4�P----- c. -----------------------------------------------Title - � ----- -------- <br /> - -------- ------- - <br /> (Plot plan, showing size of lot, locafion of system n relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY r DATE ------ ------- ------------------ <br /> REVIEWEDBY----------------------------------------------------------------------------------- ----------------------- ------------------ DATE------ ---------------------------------------------------- <br /> BUILDING PERMIT ISSUED---------------------------------- -------- DATE--------------------_ --_. -------- <br /> Alter iios and/or r cornmendatio s:.______________________._.__-.___`e" -_t - ------------------___------- --------------------------------------------------- <br /> 4914"'A�C___,&_e7_4_56--- _10- -------------Coe_ ---------------------------------- <br /> ..___ <br /> �' �, <br /> FINAL INSPECTION BY:...-- -.--.G�l ------ ------------------- Date--.---.--�-~---�-��� <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hai <br />