Laserfiche WebLink
FOR OFFICE AJSE: <br /> APPLICATION FOR`-SANITATION PERMIT <br /> Permit No. ./ •_ .T <br /> --------- --------- --------- - {Complete in Duplicate) / <br /> �j• Date Issued _� 1`�L?.1..� � <br />----------------------_.--..--.----------.----------.--- This Permit Expires 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. 544. <br /> JOB ADDRESS AND L/OCA�TIO/N�-----�-------� p--,-►"`-"'-a[• ------ ------------......•------------------ ---• ---1 •----------------------------........-------- <br /> Owner's Name----T..&t..'.....---l.l.�-`. ..-...- --- L------ ---------------------- --------- -----------------------------------------•---.-. Phone------------------------------------ <br /> Address........-_ - 1( --- :--- --------------------------------------------------------------------------------------------------------------------------------•----•- <br /> Contractor's Name-----[ --- --------------------------------------------------_------------------------------------- --------------------------------- Phone----------------------------------- <br /> Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [I <br /> Number of living units: ----I-- Number of bedrooms✓-_- Number of baths j.... Lot size ---�D[yJf 3�1r <br /> ,.� ------ <br /> Water Supply: Public system E] Community system El Private Depth To Water Table � ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ ndy Loam E] Clay Loam C] Clay C] Adobe�ardpan E]Previous Application Made: (If yes,date-------------- --) No � New Construction: Yes W"No ❑ FHA/VA: Yes ❑ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septicank: Distance from nearest well--�TQ-(------Distance from foundation---/d_!--------Material_-- ...q( 4----- - <br /> No. of compartments-----'Z----------------Size---.rfK----YA___.Liquid depth-_-_1------------------Capacity--- <br /> a6 -••_-• <br /> ,,� r <br /> Disposal Field: Distance from nearest well---3-D-r---Distance from foundation.:��__-------_--Distance to nearest lot line..____---__.. <br /> [�f Number of lines----------------------------------Length of each line---9-_---..................Width of trench.--.@Z_ -_---_-------.-.---- <br /> Type of filter material. Depth of filter material--- Y...............Total length......._70'.-----_•_._•.-------_- <br /> Seepage Pit: Distance to nearest well-Ab6_!----------Distance from foundation__&..•-------...Distance to nearest lot line----!��__-•. <br /> Number of pits--------f_----------Lining mate riaC/- _�_ -----Size. Diameter------3,3-`'-----Depth----- Zi;S .................. <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material---.---__------.-.------------_----_- <br /> ❑ Size:..D.iameter--------------------------------------Depth----------------------------------------------------Liquid Capacity--------.-------------------gals. <br /> ------Distance from nearest building Privy: Distance from nearest well----------------------------------------- - g-- -----..._.-----------•-----------•---.. <br /> ❑ Distance to nearest lot line----------------------------------------------- --------------------------------------------------...-----•------••--------------------------- <br /> Remodelingand/or repairing (describe)------- ---------- - -- --•-----------------•----------------------•---•-•---------•---------•----•----------•-•-•---------------=•--•----=--•------• <br /> y.- <br /> —- +'�y <br /> --------------­-------------••----------------------•--------------------•--------------•-------•---------•---•--•-•------------._...-.._...------------------------....---•-•--••-----------•------------------------. --- 1 <br /> herell�y certify that I have prepared this application an4 that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations oASanuin Loc I Health District. <br /> (Signed)-----------------------------------•---------------- ----- --------- --- - -------- ---------- ----------------- ------------------------(Owner and/or Contractor] <br /> BY: -- ------ (Title)(Plot plan, showing size of lot, location a system n rls, uildings, etc., can be placed on reverse side). <br /> F FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY.---- --•---------•---------------- DATE-----l--�----- ----------------- <br /> REVIEWED BY.--------------------------------------------- ----------------- ------------------•---------------------------------------- DATE---.------.........................-------..------- <br /> ..-- (f1 <br /> BUILDINGPERMIT ISSUED--------------------------------------------------------------------.--------------------------------- DATE.-•--------------••--------------------•----f-------------- <br /> Al%raf'tons a /or recommendati <br /> ---------------------------- - - --- <br /> C� ' <br /> FINAL INSPECTION BY:..---- -.`•5...s_.- ------------- Date �/ ?' fir( " ' <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 8-59 2M 5-62 ATLAS <br />