Laserfiche WebLink
FOR OFFICE USE: , <br /> --------------------------------------------------------- <br />- -------------------------- APPLICATION FOR SANITATION PERMIT Permit No. .136!24."L <br /> ----- ---------------------- -------------- ------ (Complete in Duplicate) <br /> This Permit Expires 1 Year From Date Issued Date Issued ...L.p..` .7."TT <br /> Application is hereby'rriade 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 /> JOB ADDRESS.AND CATION._. .r r, 1��Q �' #� •��,�t1 --- <br /> Owner's Nam <br /> - /444724a, f ---- i --"---------•-----•------••------ Phone.................................... <br /> Address =_ _-- -4,540 - <br /> /. ._:... ` ----• - • -----.................. <br /> = ,� ' <br /> Contractor's Name.-. <br /> Phone- ,�-4'-• 11� <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: �fleatio <br /> Number of bedrooms _______• Number o bat s :�f-___ Lot size ............................................................ <br /> Water Supply: Public systemmmuriity system ❑ Private ❑ Depth to Water Table gtft. <br /> Character of soil to a depth : Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[Hardpan ❑ <br /> Previous Application Made: (If yes,date---.----------------) No New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: 9( I <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> I ... r <br /> p Distance from nearest well.................Distance from foundation..........----------Material---____-_+_... ......_........_......._. <br /> ....... <br /> � tic !� No. of com artm�ents_________________________Size..-•-.-.---------____-- Liquid de th___-...--..-___-._ Ca acr <br /> p } ----- 9 P� --------i I city-- <br /> IJlspos 1, F' ld: Distance from nearest well /t_ �r !stance from foundation-_./f�,1.........Distance to nearest lot line___.��..__ ... <br /> 31AI�, Number of lines..``.. --------------------------Length of each line___,7.-0_:�.............Width of trench..... �`__�! _ <br /> Type of filter material._._ (._�r�,_.Depth of filter material____/'1�'_______--.-Total length_-'� ---------------­---------­-- <br /> S <br /> '___________________________ <br /> Seeps it: 4. <br /> Distance to nearest well____ _ _Jr _ Distance fou dation__ _ c'— f <br /> W 0-._._..__..Distance to nearest lot line.__ S._______-. <br />{ y � �� Number of pits._.+_-_____-_____Lining material___ f� / .Size: Diameter___e7__; -.__...Depth -�. .j...________ Q <br /> 'C;esspool: Distance from nearest well_________________Distance from foundation-------------------Lining material--__ ..___._........________-_-_ <br /> ❑ Size: Diameter---I---------------------------------Depth---•----------------------- - -----------------Li uid Ca aci <br /> _ <br /> q p ty...:...:-------------------gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building__ ____._.__ ........................... <br /> ❑ Distance to nearest lot line -'�`�"...,r. _„ ---------•---- <br /> Remodeling and/or repairing (describe ------------ <br /> 9 L� ij <br /> ---------------- <br /> -� r <br /> ' i ==/ ---- - ---•----------------------------•----------•- -•---------`--- ^ ---- <br /> t <br /> hereby cert!: , that I hav e d this applicafion­-alld-that the work wiII-6e done inaccordance with San Joaquin County <br /> ordinances. Stat s, d as and re ulations of the'San:Joa Local Health District. I <br /> a <br /> A-1 <br /> y <br /> {Signed} - ---.._._... � -1.11 -- `-��- r-- - � --- _ her end/or Contractor) <br /> By: ------------------------------------r--- --- -: .1.Q�-- ---- G�_T ...{Title] . --------- <br /> (Plot plan. showing size of lot, location of system • e ation to wells, buildings, i 'til., can be placed on reverse side). C; <br /> . f <br /> FOR ARTME USE ONLY <br /> APPLICATION ACCEPTED Br---------------- `- -- DATEa�• -Z-- ••-•• <br /> REVIEWEDBY------------ --- ••------------------------------------------------------ ----•--- -----------------------._ - DATE.... <br /> BUILDINGPERMIT ISSUED --.......=------------------------------------------------•-•--------------------------------- DATE----------------------•--•----- <br /> Alterations and/or recommendations: f ---------- ---G�.......... ----------------------------------------- <br /> r - a <br /> - _ <br /> .............. --- -- -'-`------- � ------------------­-----r'` :r`' `'! <br /> -rte _r e, <br /> ----- <br /> ._.. <br /> --- -.... <br /> � • <br /> FINAL INSPECTION BY---------------- i-------------------------- ........---- Date---------- -------------------------------- <br /> SAN <br /> ------------------------------SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak street 124 Sycamore Street <br /> Y 205 West 9th street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 8.59 2M 6-E[ ATLAS <br /> y' <br />