Laserfiche WebLink
APPLICATION FOR SANITATION PERMIT Permit N0. ----7d <br /> ------ <br /> (Complete in Duplicate) <br /> Date Issued ------ S-- 6.. <br /> pplical-ion is hereby made to the San Joaquin Local Health. District for a permit to construct ancl•install the work herein described. <br /> This application is made in comp71i3cWifh county-Ordinance No'. 549. <br /> JOB ADDRESS AND LOCATI ------------------------------------------- <br /> 000 - -------------- ------ -------- -- ---- Phone. <br /> ner s ------------------ ------------- - - - <br /> Address.m240-40-4-Aff.....��_WAe;sf- -C47------ - ----_--------------:--------------------------------------------------------- <br /> Contractor's Name------------------------------------------------------------------------- ------------------------------------------------- ----------------- Phone----------------------------------- f <br /> Installation <br /> hone----------------------------------- <br /> Installation will serve- Residence ffll Apartment House [] Commercial F] Trailer Court E] Motel [-] Other [I <br /> Number of living units: -------- Number of bedrooms j-_- Number of baths %/- Lot size -------------------------- <br /> Water Supply: Public system El Community system El Privite X Depth to Wafer Table/4.- ft. <br /> Character of soil to a depth of 3 feet: Sand [I , Gravel F] Sandy Loam D( Clay Loam ❑ Clay [I Adobe E] Hardpan [] <br /> Previous Application Made: Yes 0 No New Construction. Yes!g No E] <br /> TYPE.OF INSTALLATION AND SPECIFICATIONS: <br /> r cesspool permitted if PuAlic—sewer iss available ie-i.) <br /> ----(No- sep-ii—cfaink-o I abli—wit-9W206 <br /> f <br /> Septic Tank: Distance from nearest wellDistance from foundation--/,2....... -------------- <br /> if. d t <br /> I)L-Liquid dept h ------------C <br /> No. of compartments-- -----------------Size--- apacity__15�- ---------_-- <br /> Disposal <br /> ----- <br /> Disposal Field: Distance from nearest wel1_4_4......Distance from foundation--jJ.V.�-.,.,-Distance to nearest lot line- ------------ <br /> Number of lines----------A------------_-----Length of each ---Width of trench-----J--&*---------------------- S-:- <br /> W1 Type of filter mate ria 1.400-W.....-Depth of filter material---.------ length----40lU_0__0 1?------------------- <br /> Seepage Pit: Distance to nearest well--------------------`Distance from foundation-----------------_-.Distance to nearest lot line------------_-_-_ mEl Number of pits------------------___Lining material-----------------------Size: Diameter.--.-----------.-------Depth-----------______--_------------- <br /> Cesspool: Distance from nearest well------------- ---Uistance from foundation__---.---------_- Lining material-------------------------------------- <br /> ❑ Size: Diameter----- ---------------------------_-Depth----------- •----------------- ---------.--Liquid Capacity--------------- -------�:;�ga_l S. rn <br /> Privy: Distance from nearest well------------- --_-----------------------------_Distance from nearest building-------------------------------------- <br /> E-1- Distance to nearest lot line--------------------------- <br /> - -------------------------------------- ---------------------------------------------------------------------- 0 <br /> Remodelingand/or repairing (describe):------------------ ------------------------------------------------------------------------------------------------------------------------------------ <br /> ------------------------------------------------------------------------------------- ------------ '------------------- -----------------------------------------------------------I------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------I---------------------------------------------------------------- <br /> -------------------------- ---I--------------------------------------------------------­-------------------------------------------------------------------------------------------------------- ------------------- <br /> 1-hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, Sta;feris, and rules and iegula of the San Joaquin Local Health District. <br /> 1010 <br /> [Signed)------ ...... 0001'r ----------%._�-----------------------(Owner and/or Contractor) <br /> a-ftp zge4x------------------N-------------------------- <br /> ----------------------- ------- <br /> ------- -------------- -----------------------------------------[Title)----.. - - ---------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). (X <br /> Fq_R-QEPARYENT U5ONLY <br /> APPLICATION ACCEPTED BY-, -. -.007K --------- DATE--- ! ---f ----------------- <br /> REVIEWEDBY------------------------------------ - ----------------------- ------------------------------------------------------------- DATE------------------ ------------------------------------- <br /> BUILDINGPERMIT ISSUED----------------------- ------------------------•---------- --------------1-1----------------- DATE----- ------------------------------------------------------- <br /> Alferafions and/or recommendations:------------------ ------- ------------------------- --------------------------------------------- ------------------------------------------------------------ <br /> II <br /> ----------------------------- ---------- ----------------------------­­..........r------------------- --------------------------------------------------------------------------------------------------------------- <br /> ---------------------------------------------------------------------- - - ------------------ ----------- ------ --------------------------------- --------------------------------------------- -------------------------- <br /> ----------------------------------------------I., ------ ------- ------------------------------------------- ----------------------------------------------------------------------------- -------------------------------- <br /> -------------------------------------------------------- - ------------------------ ---------------------- -------------------- ------------------I -------------------------------------------------------------------------- <br /> FINAL INSPECTION BY:._- --- <br /> Date-- ---. <br /> -------------------------- ------------------------------------ <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, Californde Manteca, California Tracy, California <br /> E!3-]-2m 145446 A7WO9D 12-54 <br />