Laserfiche WebLink
�J /FOR OFFICE USE: <br />---------------/1-- ........ // 7 <br />APPLICATION FOR SANITATION PERMIT Permit No..l....... <br />!.. j <br />Com lett in Duplicate) <br />---- 1 - Date Issued - -�1/ <br />..�._._ This Permit Expires 1_Year From Date Issued <br />Application is hereby made to the San Joaquin Local Health District for a permif . construct and install the work herein described. <br />This application is made in compliance' with County Ordinance No. 549. <br />JOB ADDRE=SS AND LOCATION-.. _cF ._Qr/9�'�`1r�/r 1� - <br />Owner's Name --Z_11,:1--- R- -- -------------------- f ------------ Phone-----------•---------------------- <br />Address- ••...--•- ------------------------------------------------------------------------------------ -- <br />Contractor's Name � - ----�` �q--f�--------------------- Phone 6,�: 1 <br />Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br />Number of living units: -1 ----- Number of bedrooms_ Number of baths --Z-- Lot size ...-_ __ ...�%4_ _- -XI ----- /_v!_._a----- <br />Water Supply: Public system, Community system ❑ Private ❑ Depth to Water Table"�'fl ft <br />Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adob5& Hardpan ❑ <br />Previous Application Made: (If yes,date------- ........... .- I 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 />i .',-� <br />Septi Tank: Distance from nearest w f1_I+�o�t.e__ Distanire from f°°n��jation_..�i�.._._... Material - __.---------- <br />14 <br />V <br />No. of compartments... ...... .......... Sizj_Y,_:�--G-OLiquid depth_ ."�---._--Capacity-----d� <br />Disp <br />o l Field: Distance. from nearest well _�09AEX Distance from foundation _--10-_ ----- Distance to nearest lot ling-ei <br />Number of lines--�.-------___._.--__ ._.__ Length of each line__ 7..'67__`.._. ..........Width of trench..... 2._ _ <br />✓�------------fir <br />Type of filter material.. _Depth of filter material ----- �����.---- Total length ---------------------- 1t5"! ------ <br />Seepage <br />.__._ <br />See a e Pit: Distance to well-0.0.44.0g__._Distance��+fr,founds ze:nDi�e�r._. Distance �toDnep+hst� I�-._._:-- <br />p F.L e f <br />Dumber of its___ Linin maternal... <br />Cesspool: Distance from nearest well ---------------- Distance from foundation __............. ..Lining material_ --------- ------ --_------._._._-__ <br />❑ Size: Diameter.. ------ -- - ------ - ----- Depth --------------------------------------------------- Liquid Capacity ---------------------------- gals. <br />r <br />Privy: Distance from nearest well -------------------------------------------------Distance from nearest building --------------------------------- 2 ------- <br />Distance <br />-_Distance to nearest lot line ....................... - <br />s <br />Remodeling and/or repairing (describe)--------- ------------------------------------------•---------------------•---------------------------- --------------------------------------=-------- <br />t <br />-----•-------------------------------------------------- ----------------------------------------------- - --------------------------------------------------------- ----- <br />• ------------------------------------------------------------------------------------------------------------------ <br />----------------------------------------------- ------------------------------------------------- -- <br />- I ' <br />------------------------ -------------------------- -------- ------------------------------------------------------------------ --------------------------•------------ ---- <br />I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County e <br />ordinances, State laws, and rules and 'regulations of the San Joaquin Local Health District. <br />_ } _..74 1 C2 �1 _. ,cam <br />(Signed) ---- ------------ - �- - / ��- -- . �.�r.� � -------------------------------- ....... <br />TI <br />(Plot plan. showing size of lot, location, of system in relatio o wells, building etc., can be placed on reverse side). <br />! FOR DEPARTMENT USE ONLY <br />APPLICATION ACCEPTED BYC --'----------------------------------------------------- DATE ----..V�// ....`_6 -F ------- -------- <br />REVIEWEDBY----------------------------------=-------------------------------_--------------------------------------------------- DATE---------------------------------- -• ------- -------- <br />BUILDING PERMIT ISSUED-------- --------- -- <br />DATE----------- ----------------- ----- --- -------------------- <br />- ------------------------ <br />Alterations and/or recommendations:. <br />------------ -----------------------------------•---------•----- ... ----------------•-------------------------------------------------- ---- --------------------•-------------------•--------------- <br />----------------------------------------------------•--------------------------------------------------------- ---------- - --------- I -------- --=-- - --------------------- ---------- ---- -- ------------------------- <br />------------ ­ ------------------ <br />------------------------ <br />----------------------------- --------------- - - -------------------------- <br />j <br />FINAL INSPECTION BY:..__._ ................ <br />----------•------- Date------- U~ 2- i0 <br />ri9� -------------- <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 />