Laserfiche WebLink
FO 0 <br /> lcg....� <br /> - ---- ------- - APPLICATION FOR SANITATION PERMIT Permit No. ............ <br /> --------------- - ----------- <br /> ------ <br /> ------------------------- res------------ ------- (Complete in Duplicate) Date Issued <br /> ------------- This Permit Expires 1 Year From Date Issued <br /> - ------------- ----------- <br /> Application is hereby made to the San Joaquin Local Heal+h District fora permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549 1 , <br /> JOB ADDRESS AND LOCATI0j4_____/_/ --- ...... <br /> ---------------*-------- <br /> e. <br /> Owner's Name. Phone <br /> Address--_-------------- ------ - -------- ----------------­--------................ <br /> ---------- <br /> 4---------------- <br /> % <br /> ---------------- <br /> Phone.&----1p."lz <br /> _r IX❑41 <br /> ---------- ... - - -_ <br /> Contractor's Name__ - . [] Motel 0 Other [3 <br /> Installation will serve: Residence g;I,-"Apartment Ouse ornmercial ❑ Trailer Court <br /> 0 <br /> Number of living units: _'Number of bedrooms ;Z_ Number of baths __��_ Lot size-.(s//] --- ----------- <br /> le 46&,ft. <br /> Water Supply: Public system X��Ommunity system F1 Private ❑ Depth TO Water Tab -1:rardpan <br /> Character of soil to a depth of 3 feet: Sand Cj Gravel F] Sancl_"-Loam [:] Clay Loam [I Clay C] Adobe F9 <br /> ❑ <br /> Previous Application Made: (If yes,clote--- -------------- -) No 12>Ne, Construction: Yes F] No �w>F�HA/VA; Yes 0 No <br /> ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> S c Ta Distance from nearest well________________Distance from foundation------------- ------Material------------------------------------------------ <br /> No. of compartments-'--- --------------------Size-------------------------------Liquid depfh-------I------------------Capacity----------------------- <br /> D Distance from nearest well_________________Distance'stance from foundation--------- ----------Distanceto nearest lot line____.....__.-.... <br /> Number of lines---------- -----------Length of each line------------------------------Width of french.---------....._-------------- <br /> Type of filter material-------------------------Depth of filter material-------.--------------.Total length-- --------------I------------------- <br /> Seep Pit: Distance to nearest well-_t4dXA_---"Distan IF undation--1/p........Distance to nearest lot line......(Y-r. <br /> Diameter__4 <br /> Number of pits____ /-------------Lining mater' --Size: /_,Z.........Depth----- ---------- <br /> Cesspool: Distance from nearest well—------------Distanc m ounclation--------------------Lining material-------------------------- g-a-Is, <br /> --------------Depth----------------------------------------------------Liquid Capacity----------------------- <br /> El Size: Diameter.----------------------- <br /> Privy: Distance from nearest well_____________________________-__--.-----.-------Distance from nearest building----------------------------------------- <br /> Distance to nearest lot line-------------------------------------------------------------------------------------------------------------------------------------------- <br /> r <br /> m <br /> �6�'c m ou, <br /> 0 <br /> Remodeling and/or repairing (describe):------ ------------------------------------------------------------------------------------------------------------------------------------------------ <br /> ----------------*--------------------------------------------------- <br /> --------------------------------------------------------- ----- --- - ---------­-- ------------------/--------------- <br /> -----------------------------------------1--------------_----- --- ---- - -- ---------------- -- - ------6 -- ------ ..------•--------=7-------•---------------•---------- <br /> ------------ ---•------------.-------------•-----.--------• <br /> ---------------ff7n----------------------I---------- <br /> --------------------------------------------------------------I-------------------------------------------------- --------------------------------------------------------------------------------------------------------- <br /> I hereby certify t4at I have prepared this application and that the ork will be done in accordance with San Joaquin County <br /> ordinances, State ficl rules and regulations of the San Joaquin cal Health District. <br /> ----------- _vgill-w,Contractor) <br /> --- ------------------------- ------- <br /> ---- --------- <br /> (Signed)-_,* - --- ---- <br /> if - --- 4_X-Age- -----------(Title)---------------------------- ------------------- -------------- <br /> By:-------------------------------------------------------- ----- --------------- . ....... <br /> (Plot plan, showing size of lot, location of system in relafi to wells, buildin its, etc., can be placed on reverse side). <br /> FOR D5PARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY_ - -- ---- - --- - - -------------------------------------------- DATE--- --------------- <br /> REVIEWEDBY-------------------------------------------------------------------- --- ------------ --------------- --­---------------- DATE------------------ ----- ---------_-----------_--------- <br /> BUILDING PERMIT ISSUED------- - --- ----- --- ----------- - DATE_- <br /> i-o__n__s_:------ ------------------------------------------------------------------------ <br /> Alterations and/or recommendat ------- -- ---------------- -- --------- <br /> ---------------------------------------------------------------------------------- -------------- ----------------- ------------------ ---------------------------------------- --------------------------------------- <br /> ------------------ <br /> ------------------ ------------------------------------I--------------------- ------........... ---------------------/---- -------------------I---------------------------------------------- ...... <br /> -------------------------------- ------- ----------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------- <br /> ------------------------------------- -------------------------------------------------------------------- ­----------- - ­------------------I...............-------- -- -------- ------------ -- ------------ - ------ <br /> FINAL INSPECTION BY:... ........... ------- Date-(2- ----- --------- --------------------------- <br /> SAN JOAQUIN L AL HEALTH DISTRI <br /> 130 South American Street 300 st Oak Street 134 Sycamore Stre 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 6-S9 ZM 5-62 ATLAS <br />