Laserfiche WebLink
FOR OFF CE USE: r <br /> -a-- _-- <br /> '7171 - -_.-__-_-._- APPLICATION FOR SANITATION PERMIT Permit No. .. _� -1_ <br /> _._ _'�_ lJ. _ (Complete in Duplicate) (/ <br /> . ._:_t.. - Date Issued .212-1 --/ <br /> _- <br /> ---------------------- <br /> Application is hereby ma a 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. 49. ' <br /> : 4. <br /> ,ry A ___,� / _________________________________________ <br /> JOS ADDRESS AND L CAT ON ./.. r d?`, �_: L--- . ,4",4a% <br /> Owner's Name---_ z----- - --- -------------------- Phone----------------------- <br /> --------------------- <br /> o <br /> -E-- ----- - - - -------- ----- <br /> Address...... t <br /> e--'---- --- --- --• - &v -- -- Phone : <br /> r ----- <br /> InstallationContractor's NamInstallation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [I <br /> Number-of living units:.__, -- Number of bedrooms,_- Number of baths -4--_ Lot size �j---------------------------- <br /> r <br /> Water Supply: Public system Community system El Private.❑-.,Depth to Water Table _74!Pft. $ <br /> Character of soil to a Idepth of 3 feet: Sand ❑ Gravel ❑ ' Sandy Loam E+5-'Clay Loam ❑ Clay ❑ Adobe (] Hardpan ❑ <br /> Previous Application '.Made. Ilf yes,date----------- -------- 4No Z�'' New (spnstruction: Yes (Z?'--No-[] FHA/VA5'Yes [�4— N Y <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted .if public sewer is available within 200 feet.)- <br /> Septic <br /> _vim __ <br /> Septic Tank: Distance from nearest well:''':_.-�'--'___�"Distance frorri"found'af�ion_=.��___:__.Mate�lal ,�:��.1'�f_:__________________ i <br /> qr No. of compartments-_-_- `1 -----------------Size47_61 ; --- Q- _Liquid depth-__--- <br /> ---------------Capacity__ _4?_.___ J <br /> Disposal Field: Distance from nearesflwell-..' _-:_-__-.Distance from foundation.-_ Q'_----..Distance to nearest lot <br /> \.'Len th of each line._-- w -------------------------- <br /> Depth <br /> . r` Number of lines---._{�.------/-,'--_------- 9 ��-=���'...Width of trench--�w._--------;------------------ � # <br /> } of filter mat t iaLl� �tDepth of filter material___ _`_ ____Total,•langth____ �2 _---------------------- <br /> Type <br /> '��". ` ___Distance from foundation-�'_:_ -----------Dlstan e to nearest lot line_- J <br /> p g ____Linin material-_-/_e01.e i___.Size: Diameter._. ��...___Depth-12.10--- <br /> Number � c ` <br /> See a e Pit: Distance to nearest e f <br /> 4 of pits-------� rrg -•� <br /> Cesspool. Distance from nearest well '#----------Distance from foundation `Lining <br /> � material----- . _-_ ___ ___________- <br /> Ca acify '.----------- gals,-Size:- <br /> Privy: <br /> 4l <br /> { Distance from nearest well---------- --- --------------- _--__...Distance from nearest-building --_---:_.____-_--_----__---_-.----_-_.-. <br /> ❑ l Distance to nearest_ lot line----- - ------- ------=-------------------•---------------------------- -------------------------------- ---------------------------= -:Remodeling land/or repairing (describe):---------- - -- --- ------------------------------------------------------- <br /> --------- -------------------------------------------------- <br /> : r; <br /> -----------------------------------------------•-------•---•----------------I-----•----------------------------- <br /> ---------------------------- '-----°------------------------- -----------------------•------------- --------------------------------------------------:---------- --------------------------------- <br /> 4' 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, and:'rules and `regulations of the San Joaquin Local Health District. <br /> (Signed) <br /> By: <br /> � ' ✓�C✓ = - -a {or Contractor) <br /> i , , <br /> E Sy:-- =. {Title . rte <br /> (Plot plan, showing size of Iof,,Iocatiant f sysfe irelatio�fo ells, buildings, efc.,.can be placed on reverse side). I <br /> f € FOR DEPARTMENT USE ONLY { <br /> r--`� <br /> APPLICATIOWACCEPTED BY -- - - --- - s <br /> ��-. ------ DATE- ---�- - -------------.-- <br /> REVIEWEDBY------------------ - --------------------------- DATE--------------------------------­-------­---------------- <br /> BUILDING <br /> ------------------------ <br /> BUILDINGPERMIT ISSUED------------------------------------------------------------- ------ DATE------------------------------------------------------------ <br /> Alterations <br /> ---------------------- ---Alterations and or ecommendations------------ ---- ( ' .---- .._ ___ _ x _._ -:___ ____ __ _.. 7�_ ------- <br /> ------------------------- <br /> -----•------------------ ' `{ '--------�-------------------- --- ------- --------------------------------------�----, -------------------------- <br /> - Gam- f'�--------------------------- ?7 <br /> -`---------------------------------•-y---- -- --f'----- `-------�C -�----- -�"----.�"-�_ .e.!r.�e�C:.•_tom--t--------------------- f <br /> �C jt_c -s _L <br /> _ �-t/r` - <br /> 7 1[✓ f� <br /> '�.L +^y <br /> Jf ---- Date--- <br /> FINAL f SPECTION BY:----1�----------- -- - - ----- - ------------- ------ --� -------------------- ----------SAN JOAQU,IN LOCAL-HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street p 265 West 9th Street 1 <br /> ��/(/4.e.-c-c-w�i�- �} fig—.�.�+ 7.c--r•--1 <br /> Stockton,California Lodi,California Manteca,California r. ir�cy California <br /> ES 9 REVISEC 9.59 3M 3-'63 F.R120. / F <br />