Laserfiche WebLink
APPLICATION FOR SANITATION PERMIT Permit No. .. <br /> (Complete in Duplicate) Date Issued ---t-)ojat <br /> Tglica4-ion is hereby"made to the 5 Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This bpplication is made in compliance with County Ordinance No. 549. <br /> - v <br /> JOB'ADDRESS AND i-LOCATION----------------3�!�_ W----el <br /> ----- r�. .s__--- V = <br /> Owner's.Name-----------=---------' --•----Yl_lox-------h '40k4 --- Phone------------------------------------------- <br /> Address-•-•-•-----•----- ` <br /> -------------__ .✓ -__-WILY�L1lAE+ --•------• -------------•----•--------------------------------------------------------------------- <br /> Contractor's Name ----------- --------- ------------ ------------------'---------------------•---------I•----•- •--•-------------- Phone ----- <br /> i <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _ _____ Number of bedrooms Number of baths ._Q_ Lot size ____ _. 1_,ro_______________._..__._.-_.-__ r <br /> Water Supply: Public system- Community system ❑ Private ❑ " Depth to Water:Table -------- ft. <br /> Character of soil to a�depth of 3 feet: Sand F1 Gravel [❑ Sandy Loam ❑ Clay Loam ❑ �' <br /> Clay ❑ Adobe ' Hardpan ❑ <br /> Previous Application Made: Yes E] No New Construction: Yes [j No E] � <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: # <br /> t (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well________________—Distance from foundation--------------------Materiai----------------.------.-..__-_-___---__...___-_-. <br /> N;. of compartments-------------=------------Size--------------------------------Liquid depth--------------------------Capacity----------------------- 1 <br /> Disposal Field: Distance from nearest well:.................Distance from foundation--------------------Distance to nearest lot line................. <br /> F-1Numberof lines------------ _--.-._---_--Length of each line---------------------- ---.Width of french------------------.---------------- <br /> Type of filter material---------------------------Depth of filter material--------------- ------Total length----------------.--------------------------- "VJ <br /> See ge Pit: Distance to nearest well..--------------: ...:..Distance from foundation___.---------•_-___ Distance to nearest lot line----------------- IN\ok <br /> � <br /> Number of pits Lining material = Size: Diameter Depfn_: - ----•------------- <br /> Cesspool: Distance from nearest well-_. _ _Distance from foundation---�_.__._;___._.Lining material__._.-___ _ __ .__._-__-______ <br /> Size: Diameter....__�_/__ ------.---Liquid Ca acit gals. <br /> F t 7 �-�--�------3- Depth----- ------=--•-- ------.r:------ � q p Y- ---•- --- - -----g �yl <br /> Pn y: Distance rom nearest well___..__ __________________________________________Distance from nearest building.__.______.__.________________._________. <br /> ❑ Distance to nearest'lot'line----__'".------------------------------------ <br /> Remodelingand/or repairing (describe) ---- --------- -- --- -----------------------------------------------------------------------------1----------.----------------------------- <br /> I 1 <br /> --------------------------------------------.1 <br /> -------------------•---------------------`'--------....----------------------. ---------------------------------------------------------------- ----------------------- i <br /> . � _ _ y z . <br /> _______'_____________________________________________________________________________________________________________________________________________________________________________________________________________________ f <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) __ Owner and/or Contractor <br /> . _ --------------- ----- -- { ) <br /> By:----•------------------------------------------------------ '---------------------------------------------------- -----------------------•--(Title)-------------------------------------------- ---------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY t <br /> APPLICATION ACCEPTED BY -----------------'------ DATE , <br /> REVIEWED BY---------------------------- --------------------- DATE_ <br /> 4kN_ <br /> BUILDINGPERMIT ISSUED -----------------------------------------------------------.-------._ DATE ----------------------- --------- <br /> Alterationsand/or recommendations:--=--...._----------- - -- ---F ---------:.------------------------------------------------------------------------------------------------------------------- <br /> -------•----------------------------'---------------------------.----------- ---------------- ----------------------------------------------.-._-_._------------------------ ------------------- ------........•-•........ <br /> ---- -------------------------------------- ----------------------------------------- •------------------ ------------. ------ -----------•-----------------------------------------------•- ' <br /> ------------ -------------------------•-------------------------------------- ------ ------- ----•------------------- <br /> FINAL INSPECTION BY:: -----= ------ Date. '" <br /> .-------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Sfreet 300 Wesf Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, "California Manteca, California Tracy, California <br /> E5-9-2M 145446 ATWOOO 12-54 <br />