Laserfiche WebLink
FOR OFFICE USE: <br /> 5~ APPLICATION FOR SANITATION PERMIT <br /> r Permit No: :.�.� --.•- �-� <br /> -------------------- .--_._...�;?__V( A (Complete in Duplicate) Date Issued 'f - - <br /> ------------- ----- f_.__. --------- <br /> -------1 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 mad in corqpliance with County Ordinance No. 549. <br /> JOB ADDRESS AND­LOC TION------•-.----------------------a&--------- - --•A�5----------------------•---•------- ALL------- —.2........ <br /> _. ._ ` , _-:. ------------------------------------------------••---------- <br /> Owner's Name...._-- Phone.` - ..._ <br /> .{• - --------------•- <br /> Address-----.- --------------- <br /> � -----------•----------------------• •--------------••-•----------Contractors Name----•----------._ ..._.... Phone.. <br /> ` <br /> Installation will serve: Residence, Apartment House ❑ Commercial ❑ Trailer Court.❑ Motel ❑ Other ❑ <br /> Number of living units---------- Number of bedrooms _ ;"-Number of baths '' --: Lot size 8------------------- <br /> Water Supply: Public system 0 -Community system ❑ Private ❑ Depth to Water Table _ _4 ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam,& Clay ❑ Adobe Hardpan ❑ <br /> Previous Application Made: (if yes,date---- �` . J No ❑ New Construction: Yes 0@ No ❑ FHA/VA. Yes ❑ No,4 1 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> . Ag'1_�a <br /> Septic Tank: Distance from nearest well,'°i�_�:___I -�D•►stance from found_anon____....f�_______..Mater�al____ <br /> No. of compartments---____ `� <br /> r -- --------Size----- - Vr __.Liquid dity. . <br /> epfih----- ---------._CaacL? . ... ... <br /> P <br /> Disposal Field: Distance from nearest well4__0.X_e Distance from foundation....../_Q:l----Distance to nearest lot.line_._As... 1 <br /> Number of lines_____________ _ ` _Length of each line.________�� _f ____.Width oftrench-----� 6__._...... <br /> 4 g <br /> Type of filter material _f; --Depth of filter materia!_._-.-_ _ -----Total length__________________� --__-_•-•--_._--..__ <br /> Seepage Pit: Distance to nearest well_ �l!t `4 '_.__Distance from fou dation__....�V------Distac to nearest lot line-f._�-._._.. <br /> Number of pits-------- _. .------Lining material... Size: Diameter_____._ ' :---------Depth_______�x,4_�_------------------ <br /> Cesspool: Distance from nearest well_AP211J;.-Distance from foundation--------------------Lining material----------------.-______--_--.----_ <br /> ❑ Size: Diameter----•---------------------------------Depth----------------------------------------------------Liquid .Capacity...........-----------------gals. <br /> 1 <br /> Privy: Distance from nearest well---- .:.----=---------------Distance from nearest building--------.i_:.:...--__--•------•---,-_-... <br /> ❑ Distance to-nearest lot line----------------------------------------------------------------------- ....---------..--------•---------------------------... = <br /> Remodelingand/or repairing (describe)-------------------------------------------------------------------------•------------------------------------------------------------------•-••--------- <br /> ------------------------------------------------------------------------------------- <br /> ------------•-•-------•--------------------•--•------------- ----------••- ---------------------•-----------------•--------------•----------------•------•-----•-•--------•---•••------------------------------------------ <br /> I hereby certify that 1 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 /> ,� Owner and/or Contractor <br /> {Signed) •-� La .' ._.d: _?-� —= - =w` = = _.. - { <br /> U TifL'L.c'!"[� -- -----------------(Title)------------------------- <br /> $Y• ---------------• -----�-•------•--- ' <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 /> l M <br /> I APPLICATION ACCEPTD BY. -- ' ` � ={ ----------------------- ------- ----DATE-----C r 1 <br /> REVIEWEDBY----------------------------------------- ---------------------- -------------------------------• --------------------------- DATE-------------------------------•-•-- <br /> BUILDINGPERMIT ISSUED------------------------•------------------------------------------------- ------------------------ DATE------------------ --------------------------------------=--- <br /> Alterations and/or recommend• f ions:---____._____________ __ <br /> �___�T__..._.Ll�--.mac_•_-_'____'_.___._._`__.-__f_. <br /> _ -_......._..�_!�k___`_�_._-_.-_-_-_�__.�.____.___s._Ur.�. —�' --•------------��_ .[ <br /> - - <br /> .-- --r--- <br /> -- - - c �- <br /> r'-`-------------- <br /> -------- <br /> ._._._------- <br /> -•-•- --------- - ----------------------- <br /> 5 <br /> -' -- <br /> _____ __-f- <br /> _ ____________ - ------- r - <br /> ..............V <br /> FINAL INSPECTION BY:- Date--- _S............ --------- �f�1 ------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street ',s 300 West Oak Street 124 Sycamore Street ^? 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED B•59 2M 5-61 ATLAS <br /> t <br /> j <br />