Laserfiche WebLink
FOR OFFICE USE: <br /> t.. <br /> --_._--.--2� a____. APPLICATION FOR SANITATION PERMIT Permit No. ...................... <br /> ------ <br /> ---Z---------------- ---D (Complete lin Duplicate) <br /> 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 described. <br /> This application is made in compliance with County Ordinance No. 549, <br /> JOB ADDRESS AND LOCATION-.-.1.-3-. /-------�*p.R 9.t <br /> Owner's Name---.J _ --------------- ----------------- --------------- ------ Phone p -7..r_ ---- <br /> Address---2---C - .. _. ?.Qf' T-----------------�-------------------------------------------------- <br /> Contractor's Name-- ------------- ------- --- ----------------- Phone---S�, ivr <br /> ---------------------------------------- <br /> Installation will serve: Residence ) Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units. ..!----- Number of bedrooms of Number of baths -j----- Lot sizei.Y.Q.--.--_------------------ <br /> Water Supply: Public system ]]--Communify system ❑ Private ❑ Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 2-/Hardpan ❑ <br /> Previous Application Made: Ilfyes,date.9....`G .l No ❑ New Construction: Yes [Y o ❑ FHA/VA: Yes ❑ No <br /> 1 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) / <br /> t <br /> Septic Tank: distance from nearest well------ from foundation.-.�47-------- <br /> .Material--./? <br /> fl , <br /> ..-L----­----------------~'cec9- <br /> No. of compartments Size_ -� G..X. <br /> p ------- �Zet �------------Liquid depth---//---?----------------Capacity._.. <br /> Disposal Field: Distance from nearest well...r ...Dlstance from foundation-l—q----------Distance to nearest lot line-------------- <br /> �s� 4.71 .Width of trench-----, --ui�---- --------- <br /> Number of lines-.-._-. Length of each line.- '± '.. . x <br /> ❑� --------------------- <br /> Type of filter material.T4-;.�--------Depth of filter material---/ "------------Total length------- -----..-. \ <br /> Seepage Pit: Distance to nearest well-n.--.___Distance from foundation------- -_:i.__..Distance to nearest lot line------ .-.._ <br /> ❑�� Number of pits---, ------- Lining materials-.f 61%_ ---:Size: Diameter_.:?' ,- _------Depth--------------------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation------------------- Lining material------.-----.-------------------....- <br /> ❑ Size: Diameter----- ----- ----------Depth-------------- ----------- -------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well.---------..........---------------.-------------Distance from nearest building----------....------.--..-------- ri--.- <br /> Distance to nearest lot lire--_-------------------------------- -- --- <br /> Remodeling and/or repairing (describe):------ -` f �� 5?. /.-- -- ----------- <br /> C :X to -_ ----------- <br /> IGL � t� ------ ----- ----------------•------------------------------------------------------------------------- <br /> ----- ------ - - -------------------------------------------- --------------------- <br /> I ereby certify that I have prepared this appli anon 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 /> { <br /> (Signed) -- ----- --� � - --------------------- -- ---- - - ---------------------------------(Owner and/or Contractor) <br /> y:------------------------------------------------------------------------------------------------------- -----------------(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 <br /> APPLICATION ACCEPTED BY G� --------�------------�x._� DATE ?�/` '`�--------------------- <br /> REVIEWEDBY-------------------------------------------- ---- ---------------------------- - ------- ------------------------------------ DATE------------------------------------------------------------ <br /> BUILDING PERMIT ISSUED------------------------ - r -------- ATE-------------------------- <br /> ----- <br /> Alterations and/or recommendations:.-.-.-- . - .. .._ -,. -- ------ <br /> ��� �----�-�--'���--'----------------------���-------- ------------------------------- <br /> -----------------------------------------=----------------------------------------- --------------------------------------------------------------------------------------- ------ -------- -------- ------ ---------------- <br /> FINAL INSPECTION BY:...- 4��Z---—---------------------- Date------------ .--------- <br /> . <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haxolion Avt. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi, California Manteca,California Tracy,California <br /> F.P.CC. sE <br />