Laserfiche WebLink
.FOR OFFICE USE: r-d <br /> ' -- ----- Permit No. ../-7/- <br />------------- <br /> o. ../.._ - <br /> -------------- APPLICATION FOR SANITATION PERMIT <br /> ' ------------------------------------- ------- (Complete in Duplicate) - Date Issued---------- 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. ��J�, ZrZ -. tip—Y( <br /> i2 2 .5'• D -C c Fes[ `fes p ------------------------------------------ <br /> -•------------•------------ 7— <br /> JOB <br /> :.--- <br /> OwBnerr''sNarnSe AND Z�CATIO�`-...... r- - 1:ear---- -------------------------- ' ' Phone <br /> ----.. <br /> �' I` ---------•------------••- <br /> Address �i =' = ' j _--------------------- • L <br /> Contractor's Name-----------------------------!_/,t`P ----- ------ Phone.---------------------••----------- <br /> Installation will serve: Residence Ap rtment House ❑ Commercial ❑ Trailer Gourt ❑ Motel ❑ Other ❑ <br /> aI ,� :------------------------------ <br /> Water <br /> ---------------------------- <br /> Number of living units: __--__-.Number of bedrooms _-- Number of baths -_- --- Lot size --.- ---- , . <br /> Water Supply: Public system ❑ JCommunify system ❑ Private' , Depth to Water Table - ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobete <br /> Hardpan ❑ <br /> FMA/VA: ❑ No <br /> Previous Application Made: (If yes,date-"------------------1 No� New Construction: Yes ❑ No , <br /> l� <br /> "TYPE <br /> OF INSTALLATION`ANDTSPECIFICATIONS ,r <br /> (No septic tank or cesspool permitted if public sewer is available within:200 feet.)- r t <br /> l i G i C� <br /> SeDtti Tank: Distance from pnearest well---6 --_Distance, frroVoundation_--�--U-_---.Mte�a4- ----------------------------------------------- <br /> a <br /> �Q <br /> No. of compartments------2----------------Size----�-�1__u--x--`--•Liquid depth <br /> ----------- -----�;� Capacity----- fJl>-------- <br /> Disposal Field: Distance from nearest well...�_I?.-----.Distance from foundafion---6---0_.----Distance to nearest lot line - ------- <br /> 9,6_ <br /> -_..._ <br /> Number of lines----i�-------------------------Length of each line-------` {p----/.f------.Width of french--_- =�; -.--f------------_---- 0 <br /> i' l <br /> Type of filter material% ------,Depth of filter material length------- -_f-(Q-- -------------------- 0 <br /> Seepage Pit: Distance to nearest well----_-- _------Distance from foundation------------ ------Distance to nearest lot line-----.--_---_--._ <br /> ❑ Number of pits------------------- Lining material.--------- ------------Size: Diameter-------------- --------Depth---------......-..--------------- <br /> Cesspool: Distance from'Inearest well------------------Distance from foundation--------- -------Lining material--------------------------------------- <br /> Size: Diamete��-----'------------------------------:Depth------------------------------------ ---- <br /> = Liquid Capacity---------------------------gals. <br /> Privy: Distance.fromi nearest well ---------- ------- ------------ -- ----'- Distance-from,nearesf Building <br /> ❑ Distance to ndarest,lot <br /> r» line-----_.--_---r------- t F <br /> t <br /> repairing (detribe):-.--- ---- <br /> r <br /> -----------------••---------------- <br /> --- ---Remodeling and/or v <br /> r��- <br /> ------------------- --------------------------------- -------- - - q <br /> --------------- -c <br /> -------------------------------- <br /> J <br /> - <br /> .1 <br /> I hereby certify that l have prepared this application 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 /> 66l <br /> f ------- ------ {Owner and/or Contractor) <br /> (Signed] :L <br /> (Title)----------------------------- --------------- .. '--'-' . <br /> FBy:------------------------------•- ---- ----------------------------------------------------------- ------------------ <br /> (Plot plan, showing size of lot, locItion of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY-- -'�'------------------------------- ----------------------------------------------------------- DATE---------------------------------------------------------- <br /> REVIEWED BY----------------------------- :_IM!--------- - ------------ -----------------------' <br /> � ------ <br /> ----y-------- DAT --------- <br /> ATE--------- <br /> BUILDING PERMIT ISSUED---------4---------------- --------------------------- ----- _V------------------------ DATE----------------------------- <br /> _/ <br /> ---------------�---------� <br /> - <br /> - ------------------------ <br /> �---- <br /> -------------------Alterations and/or recommend tions:-----------------------------' ---------- - - <br /> � <br /> = -. ---------••---------- <br /> ------------------•---------------------------------------------- <br /> ---- <br /> if <br /> -----------------------------------------------------7----------------------- ------------------------------­­------ <br /> --------- - ----------------------- ----- <br /> ------------- -'------'-' " -------------- <br /> ' <br /> Date----' <br /> "l- -- ------------------------------- <br /> FINAL INSPECTION BY:....--_- --:-- ..-_ - ..--- <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 /> CS 9 REVISED B-59 3M 3-'63 F.F.CG. <br /> 0 <br />