Laserfiche WebLink
(?v <br /> APPLICATION )FR SANITATION PERMIT tPermit No. <br /> (Comp to in Duplicate) <br /> p <br /> Date Issued --- <br /> A San Joaquin Local Health District for a permit to construct and install the work h6€ '`in-described:This <br /> is hereby made to the quin <br /> is application is made in compliance with County Ordinance No. 549. 4 �Akw. <br /> _..7------------------------------------- <br /> JOB ADDRESS AND LOCATPN . . ... <br /> ----------- <br /> 4r <br /> Owner's Name----------JA _n---------- ------- -------------- <br /> jq--------e <br /> ---------------------- -- <br /> Address-------------------------------------------------------------------i--------------------------------- ........ --------------------- <br /> '7 <br /> Contractor's Name--------- _,_W .. .. ...... -------------- --------- Phone---- <br /> -------------------- <br /> Installation will serve: Residence A__X'Pariment House Ej Commercial 4E] <Trailer Court 0 Motel E3 Other E] <br /> Number of living units: --------- Number of bedrooms -3- Number of baths size ------- <br /> Water Supply: Public system E] Community sys em E] Private 8�Depth to'Wate'r Table <br /> Character of soil to a depth of 3 feet: Sand' ravel E] Sandy Loa lay Loam 0 Clay ❑ ardpan 0 <br /> Previous Application Made: Yes E] No R --New Construction: Yes No ❑ FHA/VA: Yes D <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or'cesspool permitted if public;ewer is available within 200 feet.) <br /> S4p-f i&�T&-n k-.��`Dista nCe'f ro m-nea rest�we�l-0--!!A 5'is-tan"c-'e-fro rn- <br /> No. of corn m- 'fs---- -------------- Size_m.,X___,�4!X_Y�'Li q uid dep�h------- <br /> part en ----------------Capacity...- <br /> -M <br /> Disposal Field: Distance from nearest well---oi� Distance from foundation----70/-------Distance to nearest lot line- <br /> ---------------- <br /> Number of lines--------m_�--------- Length 'of each line--------.1-, Ir----I------Width of french------ -- - ----------- <br /> Type of filter material--- --Depth of filter maferial'__1_9_fp----------Total length------ -- <br /> - - ------I----------------- <br /> -.7 <br /> Seepage Pit: Di-stance to nearest welI----------------------Distance from foundation--------------------Distance to nearest lot line__._____:_.-___. <br /> ❑ Number of p;fs------------ ---------Lining material-----------------------Size: Diameter-----------------------Depth_----- -----_----------------..-. <br /> Cesspool: <br /> epth------------------------------ <br /> Cesspo& Distance from nearest well-----------------Distance'from foundation___-'_______--____.Lining material__:___._____-----_--____________-_-_. <br /> ❑ <br /> aterial----------------------------------- <br /> 0 Size: Diameter------- -------------------------------Depth--------=__:---------------------- -----------------Liquid Capacity------------------ -----...gals. <br /> Privy: Dlsfance from nearest Well -----------------------------------------------Distance fr6m nearest building_________._____.__--_-______.__.____.___. �� <br /> ❑ Distance <br /> uilding-------------------------------- --------- <br /> Distance to nearest Iot,1ine_,___ --------'--=--------------------------------------- J <br /> Remodeling <br /> ------- ____,------------------------------------------ <br /> Remodeling and/or repairing (describe)--------------------------------------------------1-1----------------------------------------------------------------------------------------------------- <br /> . <br /> --------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------- <br /> ----------------------------------------------------- <br /> ----------------------------------I-----------------------------------------------------------------------:-------------------------------------------- --------------- <br /> -----------------------------------------------r---------------------------------I------------------------------------------------------------------------------------------------------------------------4----------------- <br /> I hereby certify that Fhave 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 Ja quin Local Health District. <br /> ti <br /> (Signed) ------------ --------------------------(Owner and/or Contractor) <br /> -------- --- ---- ----- ---------- ------------------------------- <br /> By:-------------------- .......................-•--•-----------------------------------------------------------------------­.--------(Title)-------------------------------------------------------- <br /> (Plot plan. showing size of lot, location'of system in relation to wells, buildings, 4c., can 1;e'plice-d-on reverse side): <br /> R- R,9EPA., TMENTIUSE ONLY <br /> APPLICATION ACCEPTED BY--- -----------------DATE_ <br /> --------------------------- <br /> REVIEWEDBY------------------------------------------------------------------------------------------------------------------------------ DATE--.--- -------------••-------•-----••---•----•------------- a <br /> # BUILDING <br /> ----------------------------------------------- <br /> BUILDING PERMIT ISSUED-------------------------------------------------------------------------- ------------------------ DATE---------------------- <br /> Alterations and/or recommenclations:----------------------- -----------------------------------------------------------------------------------------------------------------------­------------ <br /> ---------- <br /> -------------------------------------7-7----------------------------------------------------------------I---------------------------------------------------•---•----------------••--•-------------------•------------------------------------------------------------------------------------------------------------------------------- --------------------­--------- <br /> -------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------ - <br /> --------------------------- <br /> ----------------------------------- <br /> ---------------------------------------------- - -- ------------- ------------------------------------------------------------------------------------------------------------------ <br /> FINAL INSPECTION BY:------- Date------- 7------- -------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-7-2M Revised 1-57 F.PCO.. <br />