Laserfiche WebLink
FOR OFFICE USE: <br /> --pa----------- <br /> - ---------- ------ APPLICATION FOR SANITATION PERMIT Permit No. _1------------------ <br /> ------------------------------------- ------------------ (Complete in Duplicate) <br /> ------------------------------- ------------------------ This Permit Expires I Year From Date Issued Date 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 compliance with County Ordinance No. 549. <br /> --------------------------------------- <br /> JOB ADDRESS AND LOCATION--------------- --------y-------- ------ ------------------------ <br /> ...67 Phone--------------------------------•- <br /> Owner's Name------------- ------------ ........ ------- - ---- -------------- ----------- - <br /> Address------------------------ �_-_ ---------------- ------------ <br /> Y----------- ----------- ---------------------- --- ------------------------­--- --­--------------------- <br /> x. <br /> 77' e__-, - -- <br /> Contractor's Name--------------- v---------------------------------------------------------------------- Phone.-�Vt/,_&--- <br /> -------------- <br /> Installation will serve: Residence [9�partment House El Commercial [I Trailer Court E] Motel [] Other 0 <br /> Number of living units: ---- Number of bedrooms __Z__ Number of baths --L- Lot size ---------------------------------- <br /> Water Supply: Public system �ommunify system El Private M Depth to Wafer Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand E]. Gravel [] Sandy Loam El Clay Loam El—Clay El Adobe El Hardpan C3 <br /> Previous Application Made: (If yes,date____________________) No.8New Construction: Yes E] No [I-- FHA/VA: Yes E] No S— <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material-------------- ---------------------------------- <br /> El No. of compartments------- ---- -------------Size--------------------- ------=---Liquid clepth---------------------------Capacity.-.-------------------- <br /> Disposal Field: Distance from nearest well.................Distance from foundation--------------------Disfance.to nearest lot line-______-__.____. <br /> ❑ <br /> ine----------------- <br /> El Number of lines-----------------------------------Length of each line----------------------------.Width of-trench----------------------------------- <br /> Type of filter material-________________________Depth of filter material-----_-----_s--------Total 'length------------------------------------------ <br /> Seepage P;t- Distance to nearest well-------—---------Distance fr m founclation-Zo... ..... Distance to nearest lot line-51. - <br /> Number of pifs----/--------------Lining material- Size: Diarneter_,rl __x--------Depth-_.-2.-? ------------------ <br /> Distance nearest <br /> Cesspool: <br /> Dfffoundation Lining material-------------------------------------- <br /> IV e from ounon...----------------- <br /> ElSize: Diameter_.-.----------------------------- ------De th---------------------------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well--:7--A <br /> -----------------------------------------Distance from nearest building______-____._____________-_____-_._._. <br /> i. ❑ Distance <br /> uilding------------------------------------------- <br /> Distance to nearest lot line-- ---------------------------------------------------------------------------------------------------------------------------------- <br /> Remodeling and/or repairing {describe}:_.-.______"a,7 Z-z' --------6:X_11_5:e;1�_1_).___1,:�1------- <br /> -•---------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ---------------------------------------------- ------ <br /> a <br /> -------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------- -----I-------- <br /> ------------------------------------ --------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances,.State laws t-and-r-ults and regulations of the San Joaquin Local Health District. <br /> e�' <br /> (Signed) 01!? 1 . <br /> ------------------------- <br /> -------zs----- -V------------ ---------------------------------------------------------- --------- ----- -----(Opr a /or Contractor) <br /> ------------------------------------(Title) -------- <br /> By:----------------- -------�_Z ------- <br /> (Plot plan, showing size�W�-,,�fllroca ion ok_ 4 m in relation to wells, buildings, etc., can be placed on reverse side). <br /> �f�ya e <br /> FOR DEPARTMENT USE ONLY <br /> DATE­X _-__'57_7­6�-�-------------------- <br /> APPLICATION ACCEPTED BY----._ f-- ------------------------------------- <br /> REVIEWEDBY--------------------------------------------- ------------------ ---------------------------------------- DATE------------------------------------------------------------ <br /> BUILDING PERMIT ISSUED---------- ------- ---­. DATE------- --------------- --- --------------- ----------------- <br /> ---------------- - --- ----- - <br /> Alterations and/or recommendations:------------�- -' ---------- - ----------------------------I-------------------------------------------------------------- <br /> ------------------­-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> -------------------------- -------------------------- ----------- ----------- --------------­------------------------------------------------------------------------------------ -------------------------------------- <br /> ---------------------------------­­---------- --------------- --------------------------------------------------------------------------------- ------- ----------------------------------------------------------- <br /> ----------------------------------------------------------------------------------------------- ------ ----------------------------------------------------------------------------------­------------ ------------- <br /> FINAL INSPECTION ........ Date...... Q ............. ------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hasellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi, California Manteca,California Tracy,California <br />