Laserfiche WebLink
v-/ <br /> Iq APPLICATION FOR SANITATION PERMIT I Permit No. -/_�4. <br /> (Complete in Duplicate) � <br /> Date-Issued ---- _*V-5- Z <br /> if 0 <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. 5 9. <br /> Sf :© 5- -----------------------------------------------------------------------------------• 1 <br /> JOB ADDRESS AND LOCATION.....-__._./' ' __ _/________ ________________________ __ <br /> Owner's Name----------------------------------------htV_*-Oe7 < � 'Gtr= ----------------------------------- Phone----------------------------------- <br /> Add teas ? <br /> 21 <br /> n ( <br /> Contractor's Name..------•----------------------- x_----- " Cx7�___:~�- --•------- Phone----=�/�=�� �---------- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ r Motel ❑ Other Cj <br /> Number of living units: __4- Number of bedrooms ---/. Number of baths -/--- Lot size ___- -.---------------- <br /> Water Supply: Public system X Community system ❑ Private ❑ Depth to Water-Table_ ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeJ5 Hardpan [] <br /> Previous Application Made: Yes ❑ No W New Construction: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) f <br /> Se is Ta L Distance from nearest well-----------------Distance from foundation--------------------Material --___--____---______------____-------_____--__. { <br /> No. of compartments--------------------------Size-------------------------------Liquid depth--------------------------Capacity---------------------- <br /> 'Disposal Field: Distance from nearest well _-___-----------Distance from foundation--------------------Distance to nearest lot line_---____----__-_- <br /> ' Number of lines-----------------------------------Length of each line------------------------------Width of french----------------------------------- <br /> Type of filter material-------------------------Depth of filter material----------------------Total length------------_-_-____-----___----_-----.--_ ' <br /> See age Pit: Distance to nearest well_. -:--_Distance ro'foundation-- f__-_-__. 3sta ce to nearest lot line_ �f �/� <br /> Number of pits_- _- --------------Lining materia --Size: Diameter- _- ________.Depth-- - ---__----___-_-_ " <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material----------------------------......... <br /> ❑ Size: Diameter-------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest.building------------------- _-__-_-_-_---._----. <br /> ❑ Distance to nearest lot line----------------------------------------------------------------•------------------------------ ---------------------------------- <br /> Remodeling and/or repairing (describe)----------------------------------------------•-------------- -----------------------•----- ----------------- ------__-----------------------•--- <br /> --------------------------------------------------------------------------------------------------------------------•------------•­------------------------------------------------------------------------------------------ <br /> I hereby certify that4-have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, ai�d r les and yregulaf s-o'the San Joaquin Local.Health District. <br /> (Signed)-----Vingiseize <br /> 4- -i .. .. ----------------- ;, ----- - Contractor] <br /> By: ^� A--- --- -------------------------------------------------------------- r+le}`-- c-?-,G -�----------------------- <br /> y � [ 1 <br /> (Plot, plan, of lot, loc tion of system in relation +o wells, buildings, etc., can be pl ced an reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-- --------- - ----------------------------- DATE''_'_'_----------------------------------- <br /> --------------- <br /> REVIEWEDBY---------------------'------------ --- - ---------------------------------------------------------------------------------- DATE-- <br /> Alterations and/or recornmendations--------------- ----- ---- --- -- ------- ------------------------------�------�-- DATE-----'�_ . <br /> BUILDING PERMIT ISSUED--------------------------------------------------------------- <br /> ---------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------ <br /> -------------------------------------------------------------------- -------------------------------------------------------------------------------------------- ------------------------------------------------------------ <br /> -- ------ ----- --- --------- ------------------------------------------- ----- ------------------------------- ---------------------------------------- <br /> FINAL INSPECTION BY,-."-,Z-------------- / <br /> ----,---- -- ---- - --�=",.'------ Date--------------- ----------- --------- ---------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockfon, California - Lodi, California Manteca, California Tracy, California <br /> ES-9-2M 5-51 Revised W-2100 <br />