Laserfiche WebLink
rvRvrrit-r, U=: <br /> :I <br /> ------------------------- ------------------------- <br /> -----------------­---- <br /> ----------- -------,- ------------------------ ! <br /> APPLICATION FOR SANITATION PERMIT Permit No. ..f.�_`� <br /> (Complete in Duplicate) G <br /> - "-- This Permit Expires 1 Year From Date Issued Date Issued .4.1--___�( <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the ork herein escr ed. <br /> This application is made in compliance with County Ordinance No. 549. <br /> -rS'7 g <br /> JOB ADDRESS AND�LOCATION__ - ---_-_1 . .__ -s---.------ - d '---•- <br /> Owner's Name. t ---- -- L�J�1•--------------------- ----------- Phone.------------------ <br /> Address---------------�...... 4C �`,C ------- ri <br /> _---_...� � ���e...--�. <br /> Contractor's Name---- ----------d -� <br /> ------ - __/_ •------ _--------------------------------------------------------- Phone................................... <br /> Installation will serve: Resideilce4r-Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel 0 Other <br /> Number of living units;;_�--__ Number of bedrooms .-,3__ Number of baths ...k- Lot size ._._../0 r."r--- .................................' <br /> Wafer Supply: Public system"E] Community system ❑ Private M-Depth to Water Table=yif" ft. <br /> I <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam B—Clay ❑ Adobe❑ Hardpan ❑ <br /> ..4. <br /> Previous Application Made. Ilf yes,date--------------------1 No ®-- New Construction: Yes P9—No ❑ FHA/VA: Yes ❑ No m <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> ; (No-septic fank_or_.,cesspool permit f public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well_�f:U____-_..Distance from foundation__.-/p__-_.--__..Material_______: r! - [' <br /> p .......... . .. <br /> pis <br /> Disposal Field: Distance fmpartments..____',___________ <br /> ..._$ize....... aC-i _;.....Liquid depth....Y__'__ _ <br /> Capacity.:$- Q.. q <br /> from nearest well- ,,;Distance from foundation... _.Distance to nearest lot line....0.—. .__ [� <br /> I3--- Number of lines.....------!7•-•-------------------Length of each --------------Width of french.......... _ 6 <br /> Type of filer material._._ �_ ----Depth of filter material-----/$"_.-¢_____...Total length-----------/....-_-- ............ <br /> Seepage Pit: Distance to nearest well__I:Oo_'---_._____Distance from foundation_....?.'`__..Distance to nearest lot line._____a �__._ <br /> Number of pits---- ,._______---Lining material____-17a.d.,t�___-Size. Diameter___ .."........Depth-______-.._-�:-­­--------- <br /> . <br /> Cesspool: Distance from nearest well-----------------Distance from foundation.__._._._____-____-.Lining materiaf..__.__._______..______.- __.. <br /> El Size: Diameter------•----------------- .-----Depth---------•-----.---•- --------------------- •-----Liquid Capacity gals.--- <br /> -----------------_---•-... <br /> Privy: Distance from nearest well_________________-------------_---__ <br /> .,. - -----------Distance from nearest building- --------•-------•-•-------•-----.. <br /> Distance to nearest lot line________ <br /> Remodeling and/or repairing i(describe)_---------_------------------_-------------------- <br /> ;I <br /> ----------------------------------------•-..... ---------•----•--- <br /> --•-------------•------------------------------- <br /> •--- <br /> I- <br /> 1 hereby certify that I haverepared this application and that the work will be done in accordance with San Joaquin County " <br /> ordinances, State laws, and rul' a regulations of the San Joaquin Local Health District. <br /> (Signed).• ------• /! a;i <br /> -----••. -•--------------- ----------------------------••---------------- -------------------•-•----------------.(Owner and/or Contractor) <br /> ----•-•--•------------- --------------(rile)_=_-�-----------_----------------... - _(Plot plan, showing size of lo , locof system in relation to wells, buildings, etc., can be placed on reverse side). <br /> �! FOR DEPARTMENT USE ONLY r <br /> APPLICATION ACCEPTED BY------------------------------------------------------------- C ----j�--j G--.. DATE----•------- <br /> REVIEWED BY--------------------------- <br /> =•-•--------------------•--------------- ---•• --- ----- DATE <br /> - -- ---------------- <br /> UILDING PERMIT ISSUED--- --------------------- ---------------------- DATE_..---------- <br /> - - ---------------------------------------------------•- <br /> ter ion - fions:------- - ------• ---- <br /> -------------- <br /> Alterations and/or recd a�.l Sx : F ���. <br /> ............................................ {. <br /> ------------------------------------------------ �,------------- <br /> ---------------------------------• --------------• -- <br /> -------------- <br /> FINAL INSPECTION BY:..____�l_ — / <br /> li ----• ----...- -- Date-------------------- <br /> u SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street I! 300 West Oak Street <br /> 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California <br /> Ij Tracy,California <br /> ES 9 REVISED a-59 2M 5-61 ATLAS <br />