Laserfiche WebLink
`J APPLICATION FOR SANITATION PERMIT Permit No. .=_f.3....1.._.a <br /> (Complete in Duplicate) Date Issued ----- ----------�--- <br /> ---~ This Permit Ex ires 1 Year From 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 /> �� <br /> e`er` <br /> --0_1P., -------—11 --------------------------------------------- <br /> Owner's <br /> ADDRESS AND LOCATION-------- _ -- •--------•-- -"-""""-- ----------------"-�. <br /> phone----------------------------------- <br /> Owner's Name"---;Vib ._.e.... ------- -------------------�------------ ---- <br /> ,. <br /> Address-----------------------•--------••--------------- <br /> , -..-..-•--------- Phone. <br /> Contractor's Name- <br /> Installation will serve: Residence-r-A�Aparfinent House [I Commercial Trailer Court ❑ Motel ❑ Other ❑ <br /> a tJ <br /> Number of living units: _/__ Number of bedrooms __�1Clumber of baths __ --. Lot size ----�Q--•- . <br /> Private ❑ Depth to Water Table C�r_0ft• <br /> Water Supply: Public system Community system ❑ Adobe Hardpan ❑ <br /> Character of soil to a depth of 3 feet: ' Sand E] Gravel ❑ Sandy Loam El Clay Loam ElY lay ❑ <br /> Previous Application Made: Yes [I No ❑ New Construction: Yes ElNo_FHA/VA. E] No El <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: . <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septiclank: Distance from nearest well-----------------Distance from foundation._..-._.-__.._.-..Material---------- . -a <br /> No. of compartments - Size--------------------------------Liquid depth---------------- -------- Capacity <br /> �y '§ <br /> r p I d "-_Distance to nearest lot line_-.-_ <br /> Dis osalId: Distance from nearest well._ jr1�� Distance from foundation.- Width of trench-_..c _.'fr��� --------- <br /> �`� Number of lines._.___--/----------------- Length of each line_.-�--------------- <br /> a Type of filter material.�t'G- -Depth of filter material..__.l¢-_n.---..Total length---------- v----I----------` Q <br /> r '^ <br /> ��...___.Distance to nearest lot line.... <br /> Seepa a Pit: Distance to nearest welLl�e-0--6--.---Distance from foundation. �3� -'-------------- t <br /> l Number of pits.----1---------------Lin1 11ing material__R_V.r_A Size: Diameter----._.__ -- <br /> tCesspool: Distance from nearest well.. _'Distance from foundation-------------------- material-------------------------"----- als. <br /> ---De 'th ------- ---------=---------------------------- ---Liquid Capacity g <br /> l El Size: Diameter._------------------------ ------ p - <br /> � c <br /> Distance from nearest building._.----------------------------------------- �! <br /> Privy: N <br /> Distance from nearest we ______________------------------------------------ <br /> ❑ Distance to nearest lot line---------------------------------- --------- -----"""- <br /> -------------------------------- <br /> I --------- <br /> Remodeling and/or repairing (describe):----------- ------ ------------ ----------- "----- -- -- -"-- -----------__- -- <br /> -------- --- - <br /> -- ---- <br /> ------ ------ --- - - -- <br /> -------------------------- <br /> -------------------------- <br /> ------------------------- <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 /> ordinancesX�- 'State I , and rules and regulations of the San Joaquin Local Health District. <br /> ------------------------------------ r Contractor] <br /> r <br /> [$igned} ---- --------------- <br /> l <br /> -------------------------- ---------- <br /> [Plot plan, showing size of lot, location of system in relation to ells, buildings,Al., can be placed on reverse side. <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------ - ----ice ------------------- <br /> ,REVIEWED <br /> --------- DATE <br /> ------------------------------------------------------ <br /> --------------------- DATE.--------------- ------------------------------------------ <br /> BUI LDI ED BY-- - ------ ------------ -------------------- DATE----------------------------- <br /> BUILDING PERMIT ISSUED <br /> AIt tions and/or acorn endo+ionst._._ / - ---" <br /> �.-- ��/ �iF"" I 1� v v ------- <br /> - <br /> -------------------------------- <br /> ----------------------------•--------------------- <br /> --------------- <br /> ---------­----------l * <br /> ---------------------------------------------------- - <br /> ----------------------- -------------------- -------- `` <br /> F1NAL INSPECTION BY:..-.. ..__-_._0---'-�- 7�--- <br /> --------------- <br /> Date.-....4_-.-/- .� �1 ------------------------------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT ' <br /> 300 West-Oak Street 132 Sycamore Street 814 North "C" Street <br /> l30 South American Street Trac California <br /> Stockton, California <br /> Lodi, California Manteca, California y. <br /> ES-9-2M Re�jsed 8-'59 F.P.Co. f <br />