Laserfiche WebLink
FOR OFFICE/USE: 4 <br /> -------------------- --------------- <br /> ------------------ APPLICATION FOR SANITATION PERMIT Permit'- ,No. <br /> --------------•------------- - ---- ------------------- (Complete in Duplicate) <br /> ----------------- --------------------------------------- This Permit Expires 1 Year From Date IssuedDate 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 made in complian with County Ordinance No. 549. <br /> JOB ADDRESS AND ATION �`...- ---- -IN--(-•--•4TI/- / <br /> Owner's Name..... �-- �rr'a -•------------------ ------ <br /> ---- ----- Phone------------- ------_------------ <br /> __A44Address ---------•-- ------`�a 1 ----- ��, <br /> Contractor's Name -' -�..�.-.�. �4•.= .... Phone •-•--•--_--. <br /> ---- ---:-- a <br /> Installation will serve: Residence , Apartment lAouse ❑ Commercial [:] Trailrer Court [—] Motel [I Other E]Number of living units: __-)---'N umb of bedroom_. Number of baths ___1___ Lot size _________________________________________________•----_--•__ <br /> Water Supply: Public system ommunity system ❑ Private ❑ Depth TOWafer Table_�'_7ft_ <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sand oam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan C3Previous Application Made: (If yes,date_____._--_-__ -__) No New Construction: Yes No ❑ FHA/VA: Yes ❑ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: ., <br /> (No septic tank or cesspool permitted if publicstwer is available within 200 feet I <br /> Septic Ta Distance from nearest well Distance from found`�tion____.;._ .- te 'gl___- __ �-C..�1�_—..... <br /> No. of compartments______° �.___.. ize__. _. _ _U__Liquid Ca pa <br /> rr` " -r1 <br /> Disposal Field: Distance from neare well-________________.Distance from foundation.. , �.... Distance to nearest lot line 6_..___-.--- <br /> �JNumber of lines________•___. _ ength of each line_._ __ Width of trench-------- _!______.___ <br /> ' J --- --- ---- <br /> Type of filter material._ / x!?�_- Depth of filter material_____ __.'Y________Total length......... __5v____________________ <br /> Seepage P' Distance to nearest well____ _____Distance from foundation_ _/__---_-- Ij�tante to nearest lot <br /> Number of pits---- � - 1c <br /> ?- Lining material___ DC�_ Size: Diameter_ J._ ---------De t _= tline"_______l_______._ <br /> Cesspool: <br /> Distance from 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 /> ❑ Distance to nearest lot line----------------------------------------------------------•-•-------------•-••-------------------•--•-•---•------••--------..----------------- I <br /> Remodeling and/or repairing (describe)-----------------� .... - <br /> - !. .�,.......... <br /> ---•--------•--•----••-----•--------------••---•----•----•-- ---••------ <br /> -- ------ ---------•----------- <br /> - <br /> -----------------------------------------••---------------------------- ------------P'"•'1•---•­-------------------------•-•----- i <br /> -----------------------------------------------------------------------------------'-- 4 I <br /> -------------------------------------------------------------------------------------- <br /> I hereby cern t I have prepared this application and that the work will be done in accordance with San Joaquin County i <br /> ordinances, State a and rules regulations of the-San Joaquin Local Health District. ' <br /> t9. Owner and/or Contractor <br /> (Signed)------ ---- - - --- ------- Z { / ) <br /> Title ." <br /> (Plot plan, showing size of , location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY -----------•--------------------------------------•---------•------------•----•-•- DATE------------------------------------ ' <br /> REVIEWED BY---------------------- •- - - _ `--- - DATE-------------------.................................. <br /> BUILDING PERMIT ISSUED-------------------•�-• ' ----- -- D <br /> Alterations and/or recommendations:---f 1'S - .3r d•--.------• ----•--------------------- ---- - <br /> --------------------------- <br /> -----•----•--------•.........................••----------------- ------- ---- ---- <br /> ----- •--•---------------- ------------------------------------------------ ------------------ ------------- -------------------------------------------------------------- ----------=------------------ =-----------=--- ; <br /> FINAL INSPECTION ----- Date---- <br /> --:------------ <br /> SA OAQUIN CAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9Th Street <br /> Stockton,California Lodir California Manteca,California Tracy,California <br /> ES 9 REVISED 6-59 ZM 5-62 ATLAS - <br />