Laserfiche WebLink
FOR OFFICE USE: .-, <br /> ------------------5'` APPLICATION FOR SANITATION PERMIT �Permit No. . _` <br /> ---------- ----------- --------- <br /> (Complete in Duplicate) Date Issued <br /> _.-- This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descrbed. <br /> This application is made in compliance with County Ordinance - o. 549. <br /> / r /�---------- <br /> JOB ADDRESS AND LOCATION-------- <-- - <br /> //�� <br /> Owner's Name------------------- -.•- - ._ ------- Phone-- <br /> Address------------------------- ----- l-1_ _ y---------- <br /> Contractor`s Name-------------- <br /> ------•• - --- -• --------------- Phone---•-- •----•-•-----•---...------ <br /> -- <br /> Installation will serve: Residence Apartment House;❑ww Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __-I__ Number of bedrooms __ ;_!Number f`baths__�__ Lot size 1 <br /> X ----------------- <br /> Water Supply: Public system ❑ Community system ❑ Private ©Depth to Water Tab4e 'ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam E]-'Clay ❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date--------------------) No ❑�"New Construction: Yes ❑ No B--_FHA/VA: Yes ❑ No E— <br /> t i <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> s, <br /> Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material -_-_--__--__--_____--__-________-----_--_____. <br /> QE <br /> ❑ No. of compartments Size .- Liquid de�h Capacity <br /> Disposal Field: Distance from nearest well ---._Distance from foundation_------------- <br /> Z40 ----------------- <br /> --- to nearest 1ot�ne____ ...__ <br /> Number of lines----- __Length .of,' ach line__-�_-_�____Y��----.Width of trench...... __j______________ <br /> r ! - --------------------- --F <br /> ------ <br /> Type of filter material_+�IJ.Q '__�epth-of filter material_-..,/.c�_-______._Total length_______-�__ <br /> Seepa /Pit: Distance to nearest well-/Z9®----------DDiisst nce fro foundation___,/Q........Distance to nearest lot line-------- -------- <br /> Number of its---------- _ -Linin mat6riaL�_��� Size: Diameter-;--- _5-rr---Depth_.-.- ----------------- <br /> Cesspool: Distance from nearestewell-------___ :'__Distant from foundation ------------------- material_______________________________ -_ <br /> F1 - - - -----Size: Diameter---- �------- --- Depth---------------------------------------------------¢Liquid Capacity gals. <br /> ----- <br /> ar <br /> Privy: Distar?ci{_rprri,ne,arest ell-------------------------------------------- --Distance from nes; bullcling------------- ----------- <br /> ❑ Distance to nearest lot,Mina-------------------------------------- --------- <br /> - ---------------------- -------------------- ----------------- --------------------- <br /> Remodeling and/or repairing (describe):---- f ? ------ /.=5- 7 ------- <br /> --y <br /> ----------------------------------------------- ------•------------------------------------ -------- ------------------- ­ <br /> - <br /> ------------------- ---------------------------_------- - <br /> ----- -- ---- <br /> ----------- <br /> t <br /> I hereby certify that I have prepared this application a "that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations...of t e S n I aq,in Local Health District.' <br /> �. y S <br /> Owe, and/or Contractor/ 1 <br /> (Signed)-------------- ------� / --------- <br /> (Title)- <br /> - - --- - <br /> �. <br /> ------- ------------------- <br /> ��� Z_. -e r r (Title <br /> BY--------- - <br /> (Plot plan, showing size of lot, Iota 'on of system in relation to wells, build injs,,etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> �— DATE---------- /_�-C/'/ ----------- <br /> APPLICATION ACCEPTED BY------------ / <br /> REVIEWED BY_-. / ------- DATE-------- -------- ----------------------•------------------- <br /> --------------- -------------------- ---------------- <br /> BUILDINGPERMIT ISSUED------------------------------ --------------- -- - --------------------------------- ------------: DATE :-------------------- --------------- <br /> Alterations and/or recommend�ons: c - ------- ----------`---- t f <br /> ------------- - _- ------------------ <br /> ------------------------- ^ =, - - ----- ------------------------------------------------------------ <br /> �'-------------------------------- -----•.----------------- ---------------------------------------------------- <br /> ----- -------- - -�- ---- <br /> ------------------------------------------------------ <br /> ------------ ---------- <br /> FINAL INSPECTION BY:------- '`/ Lr Date- <br /> S N JOAQUIN LOCAL HEALTH DISTRICT <br /> 1641 E.Hazelton Ave. 30! West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> F.P.Cl7- <br />