Laserfiche WebLink
— APPLICATION FOR SA'NITAIION PERMIT Permit No. <br /> .................................................... <br /> -------------------------------------- ....... Y (Complete in Duplicate) Date Issued ?*4, <br /> :_.-••_--•,--------.-- F This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the Sen Joaquin Local Health District for a Hermit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549- <br /> c / � /.Df .__dflf., _•...200_.-•ftp,-ilMtiN <br /> JOB ADDRESS AND 'LOCATION ..!..___-4!l._-__-- . f /1/o <br /> Owner's I <br /> me---- <br /> (,>� .......... ..... ----------- Phone--/- <br /> ��c 7�-- _..... <br /> Contractors Name__ ----_----------------------------__ ------••-•- .........................................._... Phone-----••--•-------•---•------•-••-- <br /> 1 <br /> Installation will serve: Residence 10 Apartment House•❑ Commercial!❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> ~Number of living units: . ____ Number of bedrooms-. Number of;baths .... Lot size -A-CRE ••--:;--==`•-= <br /> Water Supply: Public system ❑ Community system ❑ Private P D6pth to Water Table F.T. it. <br /> Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam❑ Clay Loam ❑ Clay❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date....................) No 6?--New Construction: Yes ❑ No FHA/VA: Yes ❑ Nol� <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: - - <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Ta k: f Distance from nearest well_________________Distance from foundation....._-_________---Material__:...................... ........ <br /> _..__. ..... <br /> t�T No. of compartments-------•------------- --•-Size---•-=----•---...••--• ....­Liquid depth.........................Capacity...........-.......... <br /> Disposal F� � Distance from nearest ell.. .__.._Distance from foundation.l Q_.....__.._Distance to nearest lot fine. _... <br /> Number of lines')....... .(....................Length of each line_...__6:Q.____�i,_-._._.Width of trench...__3b,___ ^' <br /> Type of filter material__.ROC.�_Depth of filter material....!..............Total length..............per---=-:•••----•••Ilk '•• <br /> Jest <br /> Seepage Pit: D'stance to nearest well......................Distance from foundation_.___......_ :__:Distance to nearest lot line................. <br /> ❑ Number of pits.!. ..................Lining material........ '___.Size: Diameter___.....--......__..___.Depth._. ......_.____...__.____....__ <br /> Cesspool: Distance from snearest well---_-_.__.__..__Distance from fo'undation....................Lining material.... <br /> ElSize: Diameter....................------------------Depth...........-•---•.................................Liquid Capacity---------------------------gals k <br /> Privy: Distance from nearest well__________________________________ ........!••Distance from nearest building............. .......__-_____-.__.____--_.--------------- <br /> � <br /> ❑ Distance to nearest lot line.....;.............................. ................-.._.-•---....---------• -----•----------------••-------•------------ <br /> Rem delis and/or epairing (desc''be):__.. d�J. l•0.-111 - � -------k_le 19— f_...._ .. .7_!✓ --= = <br /> I <br /> t - <br /> ........ --•-•-----•-•----- ••••-----...••----•__•• -•--- <br /> I hereby certify that I have prepared this application and that the work will h done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations f the San Joaquin Local Health District. <br /> (Owner._.end or Contractor) <br /> _. ,,_... .._.....--- <br /> $I sed r ��, ,__ - t <br /> ( .g ) s- <br /> s .Title <br /> (Plot plan, showing size of lot, loclilion of system in relation to wells, buildings, etc., can be placed`on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY....-- � �Z- ---------•---------•-•--------•--• -•--• DATE ` 1p <br /> REVIEWED BY _ ... ---------------- DATE......----•------..: ...--•-----••-----••--•-••._.._. .. <br /> •-------------------•--•--•-------• ---•- ---•-• -- <br /> BUILDING PERMIT ISSUED---•-- ----- .......................... DATE....................... .............................. <br /> Alterations and/or recommendations----------------- •--•-•-•.................................................................................... <br /> -----•---- ---------- -•-- --•-• ....... ..........................................-....................... <br /> ...................... --------------------------------•----• ........................ .....................L <br /> . <br /> FINAL INSPECTI ;- -__ Date__... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Mamiten Ave. 200 West Oak Strom 124 Sycoreare Street 205 Wast Vth Street <br /> Slocklon,California Lodi,California r Manteca,California Tracy,California <br /> F.P.CO. <br /> -r _ _ <br />