Laserfiche WebLink
F95R OFFICE USE: <br />........ APPLICTIONOR SANITATION PERMIT Permit No. <br />..._2 <br />.......... <br />......... ......... (Complete in Duplicate) Date Issued <br />............. ... This Permit Expires I Year From Data Issued <br />Ipplication is hereby made to the San Joaquin Local Health Disi <br />rict for a permit to construct and;ns+all fhawark herein descrmecl. <br />I <br />This application is made in compliance with County Ordinance No. 549. <br />JOB ADDRESS AND LOCATION <br />- - ----«....««-- <br />... .......... . ... <br />........... ................. .. <br />Owner's Name..... _po .1 <br />-------- <br />Address ............ ---- <br />... . . . ........... <br />Contractor's <br />Installation will serve- Residence PR''"Apartment House Q Commercial ❑ Trailer Court 71 Motel D Other 0 <br />Number of living units:,/.. Number of bedrooms -S. Number of baths A.. Lot size ...... - <br />Water Supply*. _P61:tlic system'D C6mmijnify system [] Private R?'bepth to Water Table 4e44. <br />Character of soil to a depth of 3 feet: Sand C] Gravel [] Sandy Loam n Clay Loam'Y <br />1"Clay F1 Adob; C] Hardpan 0 <br />Previous Application Made: {if yes, d;ie.....1. No Wj` New Construction: Yes ❑ No U?`THA/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 />Se -tic Tank: Distance from nearest well. .....,....:».. Distance from ....... <br />No. of compartments ___... .......01 ....... Size__ ............. - ...... __Uquid Capacity..._ ------------------ Disposal Field: Distance from nearest well.3W.I..I.- 01stance from D;sfance to nearest lot' <br />Number of Z ... ... . Length w each I'ne Width of frenciri-A..".. .... <br />Type of filter mat -Depth of filter m e a _/� ........ _,Total length <br />oriai at <br />dation Z.v .... !..Dis�a •a to nearest lot line.._.. <br />Seepa e Pit,, Distance to nearest well Distance fr i, tou�l a i �01 <br />9 Z :" .Size: ize: Diam ... Depth -04$._...._..»..._...._.. <br />ai_ Number of pats- ..............Lining ;,. � ............ Lining material.... Diameter.. <br />Cesspocl: Dislance from nearest well.._.--_-. -Distance from founc1afion.____._._. Lin; ng material.._......_ <br />....eph.,_...........­.......... Llqui6 Capacity-------------- <br />ESize: Dianetef...... ........_— <br />Privy - Distance from nearest well.__ . . ....... ........ _..Disfanca from nearest ...... <br />Distance to reanest 'lot line_ ................. . ..... . <br />Remodeling and/of repairing (doscribc): ....... -1 ..... . ...... <br />................... ........... <br />....... -------- ........ <br />.... ........ ................... ...... ............ -_............................._._...,......_1....._........ i <br />I herel;y Certify the+ I have Prepared this application and that the work will be done in accordance with San Joaquin County <br />ordinances, 'State laws, and a <br />rules and r ulaiions of the San Joaquin Local Health District. <br />s ' <br />A�or Contractor) <br />By: ........ . . . ... . ... . ......... ... <br />-------- -- " <br />(Plot plan, showing size of lot, 1-�ca+;on 04, system in rela+i a wells, buildings, efc., can be placed on reverse sicle). <br />I. re <br />FOR DEPARTMENT USE ONLY <br />DATE..... ........... .............. <br />APPLICATION ACCEPTED BY. -.1 ........ _. I— - <br />DATE__ .... ............. <br />REVIEWED BY ................. ........... ...... <br />BUILDING PERMIT ISSUED .._...... .......... ......... ­­­. ,, I ...... ........ -1 ....... <br />........... ..... . <br />1-0- . ....................... ; ............ <br />4VA w_.---- .1 ............ <br />Alterations and/or recommendations:-. <br />.............. ........... ...... ...... ...... ­....., ............... <br />. ........... - ........... --111.1 ... ...... I .... ...... ­­­­ ....... I .. . ............ 11 ........................... ­­­ ....... . _ ........... .. . ...... ...... <br />................. ­ . . ........ ­__.­_..__..____._ ........ - ................. ..... . .... <br />I <br />....................... . ..... . .... . .... . .. . . . ..................... ....... ......... -.—I..»............................. <br />-7 - ,,' <br />FINAL INSPECTION ........ Date.... .......... ....... <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />1601 E Waxalton Ays. 300 West Oak Street 124 Sycamore Street <br />Stockton, California Lodi, California Manteca, California <br />F.Rco <br />205 West 9th stmet <br />Tracy, California <br />4 <br />VA <br />