Laserfiche WebLink
APPLICATION FOR SANITATION PERMIT Permit No. ... . <br /> (Complete in Duplicate) <br /> This Permit Expires 1 Year From Date Issued Date Issued <br /> 1, 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 made in compliance with CountOr i ante No. 549., <br /> JOB ADDRESS AND CATION___ <br /> Owner's Name---------- r2�7_�- M = P�61d.G _ ------ —.41,C---- -------------- Phone------------------------------------ <br /> Address `T_Qs J �------------------•----------------•---------•--••----------------------••---••----.......---------._............. <br /> Contractor's Name � 1 f f ;�D�..fl Phone <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 <br /> Water Supply: Public system 9 Community system ❑ Private [] Depth to Water Table 4V4_ ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe,9 Hardpan ❑ <br /> Previous Application Made: Yes ❑I No.E] New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ <br /> P,+ No E]TYPE OF INSTALLATION AND SECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> 1 p � <br /> Septic k: Distance from nearest well-----------------Distance from foundation--------------------Material <br /> ______-_--________.___.________.-_-__.___._._.__.�f" <br /> �k No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity--------------- <br /> _ ------- S'`'� <br /> Dis d: Distance from nearest well---- ��Distance from foundation---/----._--_-.Distance to nearest lot line____----_--__ U`l <br /> Number of linen--•---r{--------------------------Length of each line.....IGrL---�----•.__--.Width of trench--I,?-11V/.# ..� <br /> Type of filter material------------ ------------Depth of filter material--___--___-_-_ Total length----------------------------- <br /> Seepage Pit: Distance to nearest welt_ ___ &/Af-----Distance from foundation_--. -0---------- to nearest lot line�_._-------_ Z <br /> Number of pits.-----/------------Lining material----- �&46---Size: Diameter--��------.----Depth--.0-,S--------------------- <br /> Cesspool: Distance f3-om nearest well-----------------Distance from foundation__---------------- Lining material------._.-___-_________-------------_ <br /> ❑ Size: Diameter_'-----------------------------------Depth----------------------------------------------------Liquid Capacity----------------- ---•---gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-----.---------------------------.-------- <br /> F1 Distance to nearest lot line-------------------------------------------- - ------------------------•------------- C4 <br /> -------------------------------- d <br /> Remodeli d/ iri (describe):--- 4�'=" � ..r _ --- -- -----I------ <br /> s 6h 3 <br /> I <br /> - ..... �- -r -------..--- <br /> ------------------ ------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> I hereby certify that Irhnaveed this application and that the work will be done in accordance with San Joaquin Countyordinances, State I , anegulations of the San Joaquin Local Health District. <br /> (Signed) ar/ <br /> � (Ownerr and/or Contractor} <br /> By:--...-• -------------------••-------------- ...------------------ ------- �, , <br /> [Title} <br /> ... -- <br /> (Plot plan, showing size of lot, location of system in r tion to wells, buildinn be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY__ ----------------------------------- DATE-------4?^._ <br /> REVIEWED BY 1 •---------------------- DATE <br /> BUILDING PERMIT ISSUED-------------=-I- --------=----------------...-------•-•-------------------------------- DATE. <br />:. Alterations and/or recommendationsc--------------------- ----------------------------------------------•--------------------------------------------------- <br /> ----------------------------------- <br /> j : <br /> ------- ------------------------ ----------------------------------- <br /> ` 6 �,- �� �- �r �--------------•----------- ------- ------- -------- - <br /> -------------------------------------------------------------- --------------------- <br /> -------- - ------------------------------------- --------- -- <br /> Gv <br /> FINAL INSPECTION BY:.. -------- Date--------- <br /> 3---- b v <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-9-2M Revised 8-'59 F.P.Co. ' <br />