Laserfiche WebLink
t-UK UrrlC:t u5t: <br /> ----- ------- <br /> 3/' _______________________/r_� _- APPLICATION FOR SANITATION PERMIT Permit No. <br /> ----------- -------------------------------------------- (Complete in Duplicate) Date Issued __��/�.�-�6 <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 No. 549. <br /> JOB ADDRESS AND LOCATION AO?lr-�- <br /> VI;17te&4V <br /> ----- ---- ---------------------------------------------------------------------------------------------------------------------------------------- <br /> Owner's Name .-----� _"------------- ----- Phone------------------------------------ <br /> Addresst -2{{ ---------------------------------------- ------------•-•--•---------------------------------------------------------•--••------------ <br /> Contractor's Name- c 7 s3 -.---•- - Phone----------------------------------- <br /> Installation will serve: Residence JD'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _±!_.__ Number of bedrooms _3--- Number of baths __/.__ Lot size __7c5"_x_l_4­P------------------------------------- <br /> Water Supply: Public system-{Community system ❑ Private ❑ Depth to Water Table _AQ ft. <br /> Character of foil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ . Clay Loam [] Clay ❑ Adobe Hardpan ❑ <br /> Previous Application Made: (If yes,date------- ---- --) No.15- New Construction: Yeso No ❑ FHA/VA: Yes ❑ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: F E <br /> "(No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well---'—____`__Distance from foundationdQ---------------Material___ ' <br /> [ No. of compartments------- -------------Size--- -±��-- -. '-----:_--Liquid depth__._--7t_c------------Capacity_.., <br /> Disposal Field: Distance from nearest well__'."0ri___..._.Distance from foun 4 <br /> p `dation_ __._____.___Distance to nearest lot lme.-.�........... s <br /> Number of lines------2.,.------------------------Length of each line__;?!5"__y------------------Width of trench___�0--- ---------.----- <br /> Type of filter.'- .__Depth of filter material -"____.__._Total <br /> r <br /> length----f_$'0t_�------------------------ <br /> Seepage <br /> _-___________________ <br /> $eep ge Pit: Disance to nearest well_______..-____g__---Distance from foundatDistance to nearest lot line---5 �----- <br /> Number of p'ts_____� _____Linin materia�c-Gf---....Size: Dame}ye_r---3s �.........Depth <br /> _ \ <br /> 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------------- ----------------- ------ <br /> ❑ Distance to nearest,'lot Iine--------------------------------------------------------------------------------------------- -- --------------- -----------------r------- <br /> - 5 <br /> Remodeling and/or repairing (describe)------------------------- " <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joa4Qin County- <br /> ordinances, State laws, and rules d r �Ulafion fhe, San oaquin Local Health District. <br /> k <br /> (Signed) ------------- -------------------- ---- -----------------------------------------------------------------------(Owner and/or Contractor) <br /> By:--------------------------------------------------------------- --------------------------------------------------------(Title)-------------------------I-------------- <br /> ------------------------ <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br />` V FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-------- `-- �- - (/3 DATE � /Y `'r--- <br /> REVIEWED BY------------------------- ------------------- ------------------------ DATE <br /> BUILDING PERMIT ISSUED---------------------------------------------------------------------------- #----------------------- DATE------------------------------------------------------- <br /> Alterations and/or commendations.---_` ----------- <br /> ------------- <br /> '------- -----:-•--:-'--• <br /> 77 - - -- <br /> - 7_� b- - `> � r------ <br /> FINAL INSPECTION BY: � '�/ -------------- Date-------------- /_/.... ----------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E,Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br />