Laserfiche WebLink
FOR OFFICE USE: <br /> - <br /> ------------------------------------------------------- - <br /> —APPLICATION FOR SANITATION PERMIT Permit No. <br /> --------------------- -- ---------7=--------- ---------- (Complete in Duplicate).. �/- <br /> -------------------- ------ -------------- This Permit Expires I Year From Date Issued---- ------- -- - <br /> II <br /> Application is hereby made to the Son!Joaquin Local Health District for a permit to construct and install the work herein die:qae <br /> This application is made in compliance with C r * an N 5P <br /> H ��1?12 <br /> Je <br /> JOB ADDRESS AND LOCATION!, zv� _Z/ k <br /> ----- ----- --- -------- ------------4:-------e------- ---------- --------- <br /> --------------I---------------------- <br /> Owner's Name-------/I, �1/ ----------------- ----- Phone <br /> L <br /> ---------------- ------------------------- <br /> Address---_---------------- ...../....... -------------- -------I------------------------------------------------------------------------- <br /> Contractor's Name---- --------- ---------------- ------------------ Phone.._.....--------------------------- <br /> ---------- <br /> Commercial E] Trailer JE*eH Motel 0 Other 0 <br /> Installation will s'erve:tesidence [D Apartment House ❑ <br /> Number of living units: Number of bedrooms Number of baths _1---- Lot size ----- ------------------------------ <br /> Wafer Supply: Public system 0 ."Community system [I Private � Depth to Wafer Table <br /> Character of soil to a depth of 3 feet:. Sand E] Gravel 0 Sandy Loam [� Clay Loam El Clay El Adobe El Hardpan El <br /> Previous; Application Made. (if yes,date-------_-----------) No .90 Now Construction: Yes Rj No E] FHA/VA-. Yes E] No [_1 <br /> 'i <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> "if-p-ub1iZT­sewer is ava a e wifKiK-209Tfie-f) <br /> IN6'se-ptic-fain 0 w C�ss ;permitted"cesspool <br /> Septic 'Tank: Distance from!.Pearesf well__44!-------Distance from foundation_J-1y------------Material------------------------------- --------------- <br /> No. of corn pa rtmenf s___-.2----------- ------- _Liquid depth-------- --- Capacity-----I? <br /> 1�--------------- --- -------- <br /> Disposal Field: Distance from nearest well_�_O-------Distance from foundation_Zf?.............Distance to nearest lot line__J__".i..... 4C <br /> Number of lines--------- ----------- ---Length of each line----/.h-o-----------------Width of trench_ --------------------- <br /> I' <br /> 41711Z.-17W---Depth of filter material--- Total length------/-----F----------------------- <br /> Type of '�)aferiz, <br /> L <br /> Seepage Pit: Distancefilter arm <br /> nearest wed.---- ----------------Distance from foundation---------------------Distance to nearest lot line__-.....-..---... <br /> El Number of pits-----------=---------Lining material----------------------Size: Diameter.----------------------Depth--------------------------------- <br />! Cesspool: <br /> epth--------------------------------- <br /> cesspool: Distance from'!nearest well---'-------Distance from f6undation....................Lining material_._.___..__..------.----------------- . <br /> ❑ <br /> aterial----------- ------- ----------------- <br /> 0 Size: Diamete"------------------------- ---------Depth--------- ------ :-------------------------- <br /> 4 -Liquid Liquid Capacity_.------------------------gals. <br /> - 1cl- <br /> Privy: Distance.from nearest well-7------------- -------------------11-------------Distance-from nearest building--.--. ---------------------------------- <br /> ❑ Distance to nearest lot line------ it it � t <br /> ----------------­­:---------- - -------------- ------I------- --------------------------------------- ------------------- <br /> Remodelingand/or repairing (describe):-____....................:----------------------------------------------------------------------I--------------------------------- ----------------------- <br /> --------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ---------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ._.._..-_•---------------------------------------•-------- ----------------------------------------------------------------------_T--------------------------------------------------------I------------------------------- -- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rule and regulations of the San Joaquin Local Health District. <br /> (Signed,)--- h----U------A-- --------------------- --------- -------------------------------------------------- -----------=---------------- -----(Owner and/or Contractor) <br /> , <br /> ­ <br /> ---------—-------------------------------- -----------------�r� <br /> - ----------(Tifle)----- -----------------------7-- ----------- ----------- <br /> (Plot plan, showing size of lotjocation of system in relation to.wells,,6uildings:jefc., can be placed on reverse.side). <br /> A <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-- ---------------- -- ---------------------------------------- DATE---- ------------------------ <br /> REVIEWEDBY----- --------------------------'I-------------------------------- ------------------- -------------------------------- DATE---------------------------------------------------------- <br /> BUILDINGPERMIT ISSUED----------4---------------------- -------------:­-------------------------------------- ---------- DATE------:--------------------------------------------------- -- <br /> Alterationsand/or recommendations*-------------------------------j--------------------------------------------------------------------------------------------------------------------------- <br /> 11 -------------------------------------- -------------------------------------------------------------------------- <br /> ------------------------------------- ---------------------------------------­------1-------------- <br /> ------------------------- <br /> ------------------------------------ ----------------- <br /> - ------------------- --------------- ----------- ------------------ -------------------------------------------------------------------- <br /> -------------------------I--------------------------------------------- ----------------------------------------------------------------- <br /> -------------------------------------­------------------ -------------------------- <br /> -------------------- ----------- --------------------------------- - ------------------------------ <br /> -----------------------------------­ - - -------------------- ---- - --- ---------------------------------- Date.. <br /> - <br /> D ate-- <br /> ------ ---------------------------- <br /> FINAL INSPECTION ------- -- -- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California iI Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED S-S9 31A 3-'63 F.PXD� <br />