Laserfiche WebLink
A: IM <br /> • � _..1_f:5..�•�'•�° <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) pate issued ./y�z <br /> This Permit Expires 1 Year From Date Issued <br /> is hereby made the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> ApplicationY � ���� �I r <br /> This application is made in compliance with County Ordinance No. 549. �lG `" 2 <br /> z ---------- _0-- -�_ Z------------ <br /> JOB ADDRESS AND LOCALION...... . .. .. ............. ------ ------------- - <br /> 2 6 <br /> � _ ------------- P <br /> - � <br /> Owner s Name------------------------------------ <br /> - --------------- <br /> ----------------------------------- <br /> Address------------------------------------ <br /> y <br /> Phone -----------------------•-------- ` <br /> l --- <br /> Contractor's Name---------------- ---------•--------- <br /> .11 Apartment <br /> E]Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court E] Motel ❑ <br /> 11 ------- <br /> Depth <br /> _�'�---�'-/Z_•�-------------- I <br /> Number of living units, ..�.._ Number of bedrooms - <br /> „ .. Number of baths _� Lot size ------- - - <br /> Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table ..-_... ft. <br /> Character of soil to a depth"of 3 feet: Sand F1, Gravel [I Sandy Loam El Clay Loam` Clay ❑ No obe ❑ Hardpan <br /> Previous Application Made: i!Yes El No� New Construction: Yes No ElFHA/VA: Yes ❑ [I, <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> 1 { p �'sspool permitted if public sewer is available within 200 feet.} <br /> No septic tank or cesspool � <br /> lfrom nearest well _..__.._Distance from foundation... �_------.Material_....0F <br /> �{ �p� >�'QCx —/ocx <br /> I p6+"C No. of I�ompartments--------- -!, G ------Liquid depth-- 'Ir.L. Capauty <br /> Septic Tank: Distance <br /> �--------Size---------- --------- <br /> I <br /> Disposal Field: Distance from nearest weii__ ... Distance from foundation...-. d-------.Distance to nearest lot line__...R .._..-. <br /> Number`of lines----------�_--------- -------Length of each line-------7�------------Width of trench---------- '4 ------------- <br /> ------Total length---------------- <br /> Type ofifilter material.__-F-��+'tLep#h of filter material..- __.._ <br /> Q <br /> Seepage Pit: Distance to nearest well.__...-.5�%------Distance from foundation.-.._.��-•---.Distance to nearest lot line_ <br /> Ize: h��'/Q.-----Depth.- 19=07P- <br /> Number of pits_....._:-------Lining material..��<����� Diameter.._ .__. <br /> ------------ <br /> Cesspool: Distance from nearest well..-...___....._.Distance from foundation.._..---- - Lining <br /> Cat acit gals. <br /> ❑ Size: Diameter--------------------------------------Depth----------------------------------------------- <br /> I <br /> -------------------- ----------------------- q Capacity <br /> Ii -- -_...._Distance from nearest building <br /> Privy: Distance from nearest well - - ---------- ------------------------- <br /> ❑ Distance to nearest lot line---------------------------------------------- -------------• <br /> - ---------------------- <br /> Remodeling and/or repair1ng {descr'sbe�= ----------------------------------•------------------------- ---------,-------------•-------------------------------- <br /> -------------------------------- <br /> =- -------------------------------------------------------------------------------- <br /> ---------- <br /> ------- <br /> hereby certify that I'r- -------- -------------- ----- -----------------------------•--------------- <br /> ----------------------- <br /> ------------------------------ - - - <br /> have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules d regulations of the San Joaquin Local Health District. <br /> (Signed) ---..._. <br /> � '�#' ------------------------- (Owner and/or Contractor) <br /> n d/o ntra or <br /> . (Title)-------------- <br /> By:---------=- ---- ------'� -• <br /> --------- ----------= ----------------- -----------------------------• ---------- ------------ <br /> (Plot plan, showing size of ilot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> !s <br /> FOR DEPARTMENT USE:ONLY <br /> i, <br /> APPLICATION ACCEPTED BY------------------------- ----------------- ------------ ------------ ------ <br /> DATE------- <br /> REVIEWED BY------------------ -------------------------- -------- ---- -------------- --------------------------- <br /> -- ------------ <br /> BUILDING PERMIT ISSUED-------------------- DATE <br /> i Alterations and/or recommendations:............ <br /> -------------------------------------------------------------------------------- <br /> ----------------------------------------------------------- <br /> ----------------- -- ---------------------- <br /> - - - ---------------------------------- <br /> ------------- <br /> --------------------------- <br /> ----- <br /> -------- _ ------- - <br /> ------------------------------- <br /> Iv .. -:.. ­ <br /> ------ ------------ Date.----- --- ---------- ------- ---- -------- <br /> -- -------- <br /> ----- ---------------- <br /> FINAL INSPECTION BY-------------------------------------------- <br /> -- - - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 300 West Oak Street 132 Sycamore Street 814 North •'C'• Street <br /> 130 South American Street Trac California <br /> Stockton, California ii Lodi, California Manteca, California Y• <br /> ES-9-2M Revised 8-'59 F.P Co. '''- <br />