Laserfiche WebLink
i OFFICE USE: <br /> ------ APPLICATION FOR SANITATION PERMIT .......Z <br /> Permit No. <br />--------------------------------------- ---------------- (Complete in Duplicate) Date Issued .......J� <br />------------------------ -------------------- This Permit Expires I Year From Date Issued <br /> Application is hereby'made to the San Joaquin Local Health District for a permit to construe i aInd.;,i n 11 the work herein described. <br /> This application is made' in compliance with County Ordinance Klo. 549. ffa <br /> ------ <br /> JOB ADDRESS AN ATION S_--------- ------ . . . ... . ... ................................... <br /> Owner's Name--------- ........... 45so-/x-A,,,/------- ------- -------------------------­­------------------------ Phone.................................... <br /> Address-------- - ----- ............. <br /> Contractor's Name......... - -----A <br /> Installation will serve: Residence X Apartment House E] Commercial ❑ Trailer Court [] Mofel [] Other <br /> Number of living units: Number of bedrooms Number of baths .-./... Lot <br /> Water Supply: Public system Community system [I Private E] Depth to Water Table ,/,O_ ft. <br /> Character of sail to a depth of 3 feet: Sand [I Gravel E] Sandy Loam 0 Clay Loam [j Clay E] Adobe gr Hardpan ❑ <br /> Previous Application Made: (If yes,date------------------.-) No New Construction: Yes No 0 FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: X <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> I <br /> �eptl Tank: Distance from nearest Distance from foundation-,402--------Material.... Zc A!�_. -------- <br /> No. of compartmer�*ts.......2�------------ ---Liquid depth__r4__.'f-----------Capac. .......29 <br /> FZ?1�7 W, <br /> ' <br /> Dispos,al Field: Distance from nearest ----Distance to nearest lot liner,,,..... . <br /> Number of -' ten .--.Width of trench_-...,-, .(/---------------- <br /> Type of filter material..;i?. J'K____D,pth of filter material_-- -.....Total length.......�P4!�.......................... <br /> V\ I I ' ' — t" <br /> eep"e Pit: Distance to nearestiwel W Di0ance.-I-o= stapre to nearest lo line_ <br /> S <br /> 2/?--- size: Dia <br /> Number of pifs­_�-/--------------Lin ing-mate rial, ..............Depth---------- ................ <br /> Cesspool: Distance from nearest well----- .........Distance] from foundation--------------------Lining material...----_------.-----_---------------. <br /> ❑ S¢e: Diameter- -1; i �.....D�pfh__!__ I __1-----------I_---Liquid Li�qicl Capacity-------­------------------gals. <br /> - --------------------------- ! • I- ---- <br /> t <br /> Privy: Distance from nearest well-------------------------- ------------�,_-`Distance from nearest building---------------....--------------------- <br /> nDistance to nearesAof line..-------_---------------.--.--_-.------.t'_--_I <br /> - -------------------------------------------------------- -----------_--------------- <br /> Li <br /> Remodeling and/or. repairing (clescribel -----j--------------- --------------------------------------------------------------------------------------- <br /> -----------------1-11....................... ----------.......................I---------- I� I <br /> ----------- --------------------------------------fi........ -------- ----------------------------------------------- <br /> ----------------------------------I.................. --------•••----------l= -- __j <br /> ...........I---------­----------_ I <br /> ----------­----*-----­-----------------­*--------------- <br /> ---•--••------•------------------•-----------•-•----------•--'-,- ----------------------------------- <br /> ..............I_••----•-------____••_•---__--_••-----_---_...-•----------.-.... -. <br /> I hereby certify that I have prepa d this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, St laws.7ru s and�re'qulations he San Joaquin Local Health District. <br /> (Signed)------ ....... ......... -- --- ---- -------------------------------------------•- _(Owner and/or Contractor) <br /> ------------------------------...... ............. [Title)---- ........ <br /> (Plot plan, showing size of lot, location of system in relationto wells, buildin fc.. can 69 'placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----- ---------------------------------------- DATE..j -7—-------------- <br /> REVIEWED BY............. <br /> ------------ ---------------- ---------------------------------------------- DATE_ <br /> - ------------------ <br /> BUILDING PERMIT ISSUED--------------- ---------------------------------------- DATE------- <br /> 4- ---------------*----------------------- <br /> Alterafioris and/or recommendations:... -------k ......... <br /> -----—------ <br /> ---------------------------------------------------------------------------------......I------ <br /> ..................... <br /> --------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------- <br /> ............... ---------------•--••-•----------- ------------------- --------------- ------------------- --------------­----------------------------------------I------------------ -----------------­ <br /> ----------:-------------------------­--------------------------------------------I-------------------------- ----------------------- ....... <br /> - <br /> -------------------------------------------- ----------------------- <br /> FINAL INSPECTION BY:.._� <br /> -------------- .............................. <br /> --------------- Date.. ------------- <br /> ------------------------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Svroet 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Locil,California Manteca,California Tracy,California <br /> ES 9 REVISED a-SS? 2M 5-61 ATLAS <br />