Laserfiche WebLink
FOR OFFICE USE: <br />--------------------------------------------------------- ` <br /> ------------------------------------------------------ APPLICATION FOR SANITATION PERMIT Permit No. ___/- _✓�rl <br /> ---- - ------- ------------------------------ (Complete in Duplicate). <br />---_--------_____ -------------------------- ---------- This Permit Ex ices 1 Year From Date Issued <br /> Date'lssued ________- <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein desc)ZI This application is made in compliance with County Ordinance No. 549. �QS'�� 2(np-T] <br /> JOB AQQRhSS AND LO TION____ <br /> --��`�-------•---•---•-----•------ <br /> Owner's Name.------ - Phone-------------------------------- <br /> Address-. <br /> --- --- <br /> Address--------- - r - - •------••--------- <br /> Contractor's Name-- ��.�-----� ---------------------------------------------- Pho e----------------------------------- •�] <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ 1 <br /> Number of living units: J---- Number of bedrooms : .. Number o `baths _ Lot size-_ /Z:G-__ _ r <br /> Water Supply: Public` system ❑ Community system [-IPrivateDepth to Water Table It------- ft. <br /> Character of soil to a}depth of 3 feet: Send. ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpa <br /> Previous Application Made: If yes,date------ No New Construction: Yes 0 No FHA VA: Yes 0 No <br /> TYPE�OF INSTALLATfON,AND SPECIFICATIONS: . �, <br /> �. �. (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> ptic ank: Distance from nearest well__%,_5 _ Distance6 <br /> -rte, fsom foundation--------1_Q_/Material...... . .......... ... . ........ <br /> ..... <br /> No.:of compartments -- � i uid depth--------� 1_--------Ca acitY---1��__Dis os Field: - <br /> p4.� Distance from nearest well_ ®_-----Distance from foundation to nearest lot lines_ <br /> tNumber of lines----------- _---_____._ _Length of each line______— f--__.Width of trench._-- --_ r____ __________ <br /> ' Type of filter material -. Depth of filter material.--_._.- g <br /> Y Total length v <br /> - i a � � r <br /> Seepa Pit: i Distance to nearest well------/d�.-_�Distance f am fo ndation---__-1__�_---_--.Distance`o nearest lot.lin11 ��_______ <br /> Number of pits------� -----.Lining material_-1�_Size: Diameter------. Depth --� ----------- <br /> Cesspool.- Distanee.fi•om nearest well---------------I-Distance from foundation.----------.--------Lining material----- <br /> ElSiz&.`Di5 etei ---�--------------------------:Depth----------------------------- ----------------------Liquid Capacity---------------- ---------gales <br /> Privy: .Distanee.fram nearest well-----------------------------------------------__Distance from nearest building------------------------------_----------- <br /> Distance to nearest lot line- '--------- ------------------------------------------------------------------------------------------------------------------- <br /> a , <br /> Remodeling and/or repairing (describe)------------------------•-=---------------------------------------------------•-------------------------------------------------------------------------�y f. .. .. t -- ------------------------------------------------------ <br /> E k <br /> -- --------- - --------------------- ------------- ------------- ....... <br /> ---------------- ------ - ------ ----- ------------- _________.___ .. <br /> -------------------------------{--.._---.____-___-----___----__-_----_______-------____-_----_--------_______-_--_--__------________---_____-----_--__-_______------_ ---------____----_.------._------------------ <br /> hereby cert-f that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, Stat a s, and rules and regulations of a San Joaquin Local Health District. <br /> G / <br /> { r <br /> (Signed)-------- -- �------------- --- - -- <br /> ------ :�--- --�--- - ----- ------------------ -----•------------------------------------...�. /or Contract <br /> # st- <br /> $y:- �------------- --- ---- --- ----- --------------------- :=---(Title)--------- --- ----- - <br /> (Plot plan, showing size of lot, location of system in relation to ells, buildings, etc., can be placed on-reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY- ,�_- ----- . --- -------------- -- ------- ............... DATE---- 60_-,/,?-G-3 <br /> REVIEWEDBY------------------------------------------ -- ---------------------7--.---------------- -------------------------- --------- DATE---- ----------------------------------------------- ---- <br /> BUILDING PERMIT ISSUED----------------- ------------------------­--------------------------------------------------------- DATE-------------------------- -------------------- -------------- <br /> Alterations and/or recommendations:-----------------------=------------------------------•-•--•--------•----•---•--- --------------------------------------------------------------•----------- <br /> -------•-•------------------------------ ---- ------------------------ -------------------------------------- -•---• -...- - --- <br /> ------- ------------------------------------------------------------------------ <br /> =-------------•---------------• ------------------------ <br /> -=----------- --------- - •----------------------------------- ------ -------•- <br /> y <br /> - - :' ,cam ._ ..�. +.� •wr <br /> FINAL INSPECTION BY_.. .- -- vf-------------•- D+e ._� �.. ---- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Ha:eltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 6-59 3M 3-'63 F.P.CO. f <br /> 1 <br />