|
FOR OFFICE USE•,
<br /> _. ram r Permit Na. _.
<br /> •- --------------
<br /> • APPLICATION FOR SANITATION PERMIT
<br /> (Comp!efe in Duplicate) Date Issued
<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 described.
<br /> This application,is_made,in..compliance.with..County Ordinance_No..549.,, �».....-.—
<br /> c� - ----- ---------------------------
<br /> JOB ADDRESS AND LOCATION.._.;Z 7__a-----. `? ------------•------------------ ----------
<br /> Owner's Naecme t`�—,[� '------� -----------------_ -------------------
<br /> Address.... ,_1_�O J_ - [�[ ----------------
<br /> 1�` ~�
<br /> Contractor's Name---- - ----------"-----•-------------------------------------
<br /> -------- Phone.V"——9 '
<br /> Installation will serve: Residence LSI Apartment-House ❑-Commercial'❑"`7raile_r-,Couct'❑ ,Motel L3 Other ❑
<br /> A---- Number off bedrooms, �_,N:umber.. of,baths ---/--- Lot,size tJ X-`lap-------------------------------
<br /> Number of living units: __ y z ;,, ,�, w t ,. ,.r �•. a
<br /> Water Supply: Public system R Commu�.nty system El Private F1 Depth Depth to Water Table eQ_`
<br /> Character of soil to a depth of 3 feet: Sand [-] Gravel ❑ Sandy Loam ElClay Loam El Clay E] Adobe ® Hardpan C]
<br /> r 1, w i,�. .
<br /> Previous Application Made: (1f yes,date-'.----_---�"`-"', No ® New-Construction: Yes ® No ❑ FHA/VA: Yes ❑ Na ❑
<br /> Id,
<br /> z1 A A ^A
<br /> TYPE OF INSTALLATION AND SPECIFICATIONS:,,i,,,.,.,,•..,,.....�,.L,w. , ;
<br /> (No septic tank or cesspool perniiffed if public sewer is available within 200 feet.) !
<br /> Septic Tank: Distance from nearest=well-_._-----------Distance from foundation _:-_-_--__--.-
<br /> 'Material------- ------ -----•---------------•--
<br /> No. of compartments -= Size -----------•-----_--Li uid de th- • Capacity-
<br /> . e �^ . l-----..t l� `Distance to nearest lot line__4 -------
<br /> ! 1
<br /> Disposal Field: Distance from nearest well__. -------Distance from foundation___.___ -__. K
<br /> ® O Width of trench----'
<br /> Numbe` of lines------1------ ---------�-- ---Length of each line-------- �
<br /> Type o filter material--- 0CA------Depth of filter material.----��---•-------Notal length-------U------------------------------
<br /> k ..7 rf ! h 7.l �e I / 1
<br /> Seepage Pit: Distance to nearest.well___________________.Distance from foundation__-_)_t)----.,_.,Distance to nearest lot line-!./.(). ......
<br /> t t] '3- ------------De th a t5----_ �..
<br /> Numbe of pits----"-- ---_"-.-----_.Lining material_--_ (---Size: Diameter__ p
<br /> Cesspool: Distance from nearest well________ ________Distance from foundation---._-----.____... .hiving material--------_______.._.____.__-____.__ti.
<br /> F `ILi Liquid Capacity_--', __-___gals: -
<br /> ❑ Size: Diameter--------'--- ---------- �---- --.Depth--------------------------------- --•---------- ) q --------- -
<br /> Privy: ; Distance from nearest well--------1-----------------------.---------------Distance from nearest building------------ --------------------------
<br /> ❑ 44
<br /> r
<br /> Distance to nearest lot line-----.-�'�--------------- ------'-'----------="°-----•-- --
<br /> I
<br /> Remodeling and/or repairmg (describe):---------------- ------------------ --------------------------- --------- ------- -----
<br /> It --- --------
<br /> ------------•------------------------------------------------------------------------------------------------
<br /> ------------------------------------ --•-----------------------------
<br /> ---- prepared PP n Joa uin Local
<br /> --------- ------------------------------------ ---------
<br /> f les and r uihis a li the 9 k will be done in accordance with San.Joaquin County
<br /> 1 hereby certify that I'have re ared this application and That the work Health District.
<br /> ordinances, State laws, and rules g
<br /> 1�..«..,.,a._.. )_?�.
<br /> -/--3/
<br /> ,,, ,.-� Contractor]
<br /> _
<br /> - -------d caner and/or or]
<br /> y ._Title (, �'
<br /> ;.._.,,... (Plot plan, showing-size of lot,,location.of system-in relation,to wells, buildings, etc., can,be.placed_on reverse side).
<br /> FOR'DEPARTMENT USE ONLY
<br /> APPLICATIONACCEPTED BY----. ---- -------------------------------------------------------------------•-------- DATE-----J I--;k ---------------"------..._
<br /> REVIEWED BY---------------------- ----------- -------- --- --------------------------- --- - - --- --------------- --------------•-
<br /> DATE-------------------------------------------------- ---------
<br /> BUILDING PERMIT ISSUED---------------------------------------------------------------------- - -
<br /> ------------------------- DATE--------------------------- -------------------- - ------•---
<br /> �Alte'arat�io-7n-s. _a-�nd/_oOr recommendations:__-------�----�------.---cyu� ---• - k -----
<br /> -------
<br /> ------- --- }
<br /> -- - -- ------------------------------------
<br /> - --------- ---------------------------------- ------------------------------
<br /> --------- ------------------ -----
<br /> Date.------
<br /> FINAL INSPECTION BY:.-__.-.-...r-�------------- -
<br /> /�` -----
<br /> k SAN JOAQUIN LOCAL HEALTH DISTRICT
<br /> 1601 E.Haxelton Avo. 300 West Oak Street 124 Sycam are Street 205 West 9th Street
<br /> Stockton,California Lodi,California Manteca,California Tracy,California
<br />
|