Laserfiche WebLink
F� <br /> FOR OFF1'Cc'USE <br /> -.-__-.._.,_ -_-.-. APPLICATION FOR SANITATION PERMIT brmit Alo. . `�..1 .__ <br /> 1'; (Complete in Duplicate) �— <br /> [co p L.. ... G v <br /> ' pate issued .___.. ......, <br /> -_..------- ---------------------------------------- -- This Permit Expires 1 Year From Date Issued <br /> I Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> T his application is made in compliance ' *h County Ordinance No. 549. <br /> F�.sS�'---------------------------------------- <br /> JOB ADDRESS AN LOCATION__..---•-- 7........ <br /> ------- ---•.......................•--------- <br /> Owner's Name--------- f Phone. <br /> t --------------------------------------- ----- <br /> Address..•.- .. <br /> i, <br /> ... r ' --- ------ -• -------------- <br /> Contractor's Name... _, lh,d --- 5...r.-54---__ -- ---•--•--..---- Phone--------------------- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> I' Number of living . -. Number of bedrooms ____ __ <br /> t <br /> units: ...�. Number of baths ----J_ Lot size ... ------------------------ <br /> Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table -------- ft. <br /> Character of soil to aldepth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ <br /> fPrevious Application Made: (if yes,date____________________I No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> t. (No septic tank or.cesspool permitted if public sewer is available within 200 feat.) <br /> l 4e.,s�' �+w -��' � <br /> Septic Tank: Distance from nearest well,rT Distance;,from.founda'ti'on.__j .........Material... . ...... ......:.......... <br /> No, of com artments__________._ Size_-:_ }+G_ _X_. Li uid de th._______- ._� Capacity...P q _ P. � ----------- P ty... Q.. <br /> Disposal Field: Distance from nearest well. -. _ 9 8� a from foundation. P.Distance to nearest lot line. . ........ <br /> } Number of lines---t---LS---------------------Leri fh of'each line_-_ Width of trench___________ <br /> Type of filter material._.' � ;Y.__.,Depth- of filter material______.V?_ ____Total length...•. _._3.0.x_______________________ <br /> Seepag Pit: Distance,to,nearest �Distance from fo ndation_ _ -___.Distance to nearest lot <br /> ____Linin mate Size: Diameter____. De th______. ._ <br /> Number of pits--------- � � � �� � <br /> Cesspool: Distance from nearesf well____.._-�__-_.._Distance afrom foundation__ ____ __________Lining material..................................... <br /> ❑ Size: Diamete------------------------------0......Depth----- __ -------- q-------I! Capacity---------------------------_gals. p ' <br /> Priv Distance from nearest well-______--------------------------__' -_-_Distance from nearest buildin <br /> ❑ --- ---•-•- ----------------------- <br /> Distance to nearest lot line------------------ �°'— <br /> Remodelingand/or repairing (describe):---------------------------------------------------------------------------------------------------------------------------.............................. V� <br /> L I � <br /> . -------------______---------_--------_{----------------..___..»____..--------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> a ! <br /> i <br /> ________________------ <br /> ______________------------------_-------------------------------------------------_---------------------------------------------_----------------------------------------------------------------- <br /> I hereby certify that I h e prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State law , and ales and regulations of the San Joaquin Local Health District. <br /> fi <br /> i <br /> ___________ __ (Owner and/or Contractor) <br /> t <br /> By:--------- -- (Title)--------------------------------------,........----•-- --------- <br /> -- - - - -- - - - <br /> (Plot plia , s inq size of lot, I ation of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------ .�---- ------- -- ^1•-- --�----------------------------------- DATE--/ a_•-"_�---�---0-_--4P'- ---------- <br /> 'kEVIEWED BY-----------I-------=--------------------- ----------------------------------- DATE----------------------•------------------------------------ <br /> BUILDING PERMIT ISSUED--------------------- -----------------.._._..._..--- -----------------•-- DATE------------•-----••---------------------------------------- <br /> Alterations and/or recommer�da .ion ------------------------- ___ ._.---.----..------. <br /> / tr ----�---------------- - <br /> ---- --------•---------------------------------------------------------------------------------------------------------------------------- ------------------- -..................................---------------•---- <br /> j <br /> ------------------------------------------------ --------------------------------------------------------------------------------------------­­1--------------------­ ------------------------------------------------ <br /> k <br /> yy <br /> FINAL INSPECTION BY------ -- --- --- - -- `�. �� Date------F ----T---� � ' �� ----•------•---- <br /> I [ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 west Oak Street 124 Sycamore Street 305 West 91h Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 5.99 2M 8-61 ATLAS a <br />