Laserfiche WebLink
FOR OFFICE USE: <br /> --------------- ------- ------ ---- --------------------- <br /> %X_ - --- - ---------- ......1,5��_'-_Rd_ APPLICATION FOR SANITATION PERMIT 'Permit No. <br /> ...................... <br /> ------------------------------------ --------------------—- (Complete in Duplicate) Date Issued 21 <br /> ------------ ------------------I-------------- - ---This Permit Expires 1 Year From Date Issued -- <br /> - 7­ <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the'work herein described. <br /> This application is made in compliance with County O�rdinan e No. 549. <br /> JOB ADDRESS AN POOC TION__S5_7/4�7 -------------------------------------------------------I <br /> ---------- <br /> Owner's Name--------- Phonee&__Z�.1__;? <br /> --------- -------------- ---------------------------------- <br /> Address-----------------------------------3_-Z <br /> ne------------------------------------ <br /> Contractor's Name-1,1,&, ----- <br /> --------------------- - -- --- ---- <br /> Installation will serve: Residence Prip-arfment House ❑ Commercial 0 Trailer lo'urt=E] Motel ❑ Other <br /> Number of living units: -1----- Number of bedrooms --- ---- Number of b theLot's e -------------- <br /> 'z <br /> T <br /> Water Supply: Public system E] Community system [I Private Number of <br /> o Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam E]706'Y'Loam []—Clay El` obe00�<arclpan El f <br /> Previous Application Made: (If yes,date date___________________} No E] New Construction: I Yes E] No Yes E] No'd <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet. <br /> S,55c"TA41A Distance from nearest well--____.________Distance from foundation-------------------Material____-_.-. .-._-_---_..._-_-.--_-____._':.__--_--- <br /> No, <br /> a'ferial--------- ---------- ---------------- ---------- <br /> No. of compartments-- - ---------- ----- ....size---------------- ---- ------- Liquid depth--- --------------------Capacity--------- <br /> (6K - .. — __ le I <br /> 50�Ve d4: Distance from neare -t well%_.()..O.'D�sfance-from founclafu'pri--- --- Ine-- ---------- <br /> p Lal-_.Distance to nearest lot I' <br /> Number of lines---_- Length of each line_ffo _Width of trench <br /> d - - -. jr ----------- <br /> _44 d Type of filter materia Depth of filter material ---- --- ------------Total lengfk----- <br /> Seepage Pit: Distance to nearest welL. -------- ------ <br /> Distamfe from foundation--------------------Distance to nearest lot line____-_-_-_---..- <br /> El Number of pits..- ---------- -------Lining material-----------------------Size: Diameter--.----------------.---Dept h- - -- ---------------:----------m <br /> ; <br /> . <br /> Cesspool: Distance from nearest well------------- ---Distance from foundation.-------------------Lining material---------------------------:--------- <br /> r <br /> 171 Size: Diameter---- -- - ------ -------------------Depth------------------------------------- --------------Liquid Capacity-.-------------------------gals. <br /> Privy- Distance from nearest well---------------------------------- ------- - --Distance from nearest building----- ------------------------ ---- __ <br /> ElDistance to nearest lot line------------------------- ----------------------------------------------------------------------------------- -- ----- ---------------------- <br /> Remodeling and/or repairing (descr e):-- ------ --------- - --- ------- -- - ------I------- <br /> I------------------------------------------ -------------------------- ---------------------- <br /> --------------------------------- ----------- ------------- ------ <br /> --------------------------------------------------------------------------------------- <br /> ---------- --------------------------- - ------------ -- - ----- ------------------------------------------------------------------------------------------------------ <br /> --------------------41- T it - <br /> ------------------------------------ -------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> I hereby certify that I have prepared this application " <br /> and that the work will be done in accordance with San Joaquin County <br /> cl h <br /> ordinances s <br /> e s, and ru and re yulat,7D-5fhe San Joaq Local He A District. <br /> Nf_" <br /> Sign ------ -- ------ . ..... .. .Atfs-i--------------------------- wn Contractor) <br /> By:---------------•------------------------ ---------------------------------------------- --------{Title)------------------- ------- ------------------------ J <br /> (Plot plan, showing size of lot, location of system in relation to w so buildings, eft/. can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------ --------- L/ 71 <br /> - ------------------------------ DATE--------.j�: �,15 <br /> -----/-------------------------------- <br /> REVIEWEDBY--------------------------------------Z_------------------------------------------ -------------------- ---------------- DATE-------- -------------------------------- <br /> BUILDING <br /> ATE-----------------------------------------BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------- ---------- DATE__ .---------------------------------------- - ------ <br /> Alterations and/or recommendations:---------------------------------- --------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------­---------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ----------L------ ----------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------- <br /> ----------- - - -------------------------------- ---------------- --------------------------------- ------------------------------------------------------- --- -- ------------------------- <br /> ----------------------------------------- ----------------------------- ------------------- ---------- - - ------------ -------------------- -------- <br /> ------- -------------------------- <br /> FINAL INSPECTION BY-,�-.,-.& Date.... --------------------------------------- <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 /> F.R r.M <br />