Laserfiche WebLink
FOR OFFICE USE: <br /> / •3 C1 <br /> ------------------ ----------- ----- ------- ---------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. ---- -�1°-•7-- <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 Heal#h District for a permit to c Rtruct and install the work herein described. <br /> This application is.ma.de in compliance with unty Ordinance No. 549. <br /> JOB ADDRESS AN A N__ _ __ � � _____. � <br /> Owner's Name---- - ----- -------------------- Phone--------------------- ------------ <br /> Address----------•--------_--- .------- <br /> --- -- ------ <br /> Contractor's Name------------ _ ---•-- -- --------------------------------------------------•--•-------------------------------- Phone _ __1�� <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑�. <br /> Number of living units: Number of bedrooms ---yNumber of bathso.2,r_ Lot size,,/ 'S-"�e------------------- <br /> Water Supply: Public system a-1fommunity system ❑ Private ❑ Depth to Water Table ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ lay E] AdobeE;_-i1`ardpan ElPrevious Application Made: (If yes,da#e....................I No �ew Construction: Yes to ❑ FHA/VA: Yes �o ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 240 feet.) <br /> Septic T k: Distance from nearest well_____ Distance from foundation 4_-__- Matenal--� .0._IF-----C------------------ <br /> No. of compartments_.-.�------------------ _. d-__-.Liquid depth__.__ /__/.........._.Capacity_--/-I.OLV-__ <br /> Disposal F' Id: Distance from nearest Distance from foundation-__,,-'.Io�.-_/_.Distance to nearest lot line.`!�1--__ <br /> Number of lines----- Length of each line..._... 74- d._.Width of trench-_-C <br /> Type of filter material-__ltl�_eaAVO�Depth of filter materia!_.. ��_.lTotal length------��©---/.-___ /__-__._ <br /> Seepage it: Distance to nearest well--_7'� Distance fr f.undation.__., __.._..Distance to nearest lot lin ------- 06 <br /> per, <br /> E Number of pits_..._--._-__.Lining material_._.Size: .......Depth. ----------------- <br /> Cesspool: <br /> --_ ---Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material----------._------..-----------_.._-- �3 <br /> ❑ Size: Diameter--------------------------------------Depth--------------- ------------------ ------- --------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well .........................._-----_.-____--.-._-Distance from nearest building-------.--..___----.__---_--_-_.-.-_..... <br /> ❑ Distance to nearest lot line - - - ----- - ------------------- - -- ------------------------------- -------------- ------------------------------------------------- <br /> Remodelin and/or repairing describe :------ <br /> ---------------••-•------•-•--------------------------------------------------------------- <br /> ----------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------- ------------- <br /> I hereby certif at I have repared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State and r 'And regulations of the San Joaquin Local Health District. <br /> (Signed)------ -- ���� t� (Owner and/or Contractor) <br /> By:------------------ { (Title)- �,- - - --- <br /> (Plot plan, showing size of location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----------- -- -------- --------- ---------------------------------------- DATE-------fes <br /> REVIEWED BY------------------------ ------- ------ -------- ---------------------------------------- ----------------------- --------- DATE--------------------- <br /> -------------------------------------- <br /> BUILDINGPERMIT ISSUED-------------- ------------------------------------------- --•---------------------------------------- DATE-------------------------- ---------------------------------- <br /> Alterations and/or recommendations:------------------------- -------------------------------••------_------------------------------------------------------------------------------------------- <br /> 4l-_1a-_k-Y------ -------------------------------- lo- ------------ -------------------------------------------------------------- ------------------------- <br /> ----------------- -- ---------------- ------------------------------------ <br /> ------------------------------------------- ------------------------------------ --------- -------------------------------------------------------------------------------------------------------------------------------- <br /> --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> FINAL INSPECTION BY--------------C. . c --------------------------- Date. - - - - ------ ...�.. ------------------------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Has*lion Mo. 300 West Oak street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> F.P.CO. <br /> I� <br /> t '-J <br />