Laserfiche WebLink
FOR OFFICE USE: <br />-------------------------------­­---------------------- <br /> "' <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br />----------- ----- yl_ - — �—;., . ,�,_, j <br /> (Complete in Duplicate) ­­-Dite Issued <br />-------------- .----------- ....... <br /> 41- 4t --------/------------ <br />------------------------------- _.?.7.----_I-­ Thi-s'Peiniit EiPiris1 'Yeii_r_Fi��6a_t9 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 /> JOB ADDRESS AND LO CATIQA4_ <br /> Owner's Name._---X------0V.&&d9_­­---- ---------------------------- ------ -------------------------------- Phone.....................................% <br /> Address. <br /> OA <br /> ------ <br /> Contractor's Name- A - --� - - ---- <br /> ----------------------------------------- <br /> - <br /> Phone--------- <br /> Installation will serve: Residence Apartment House [-I Commercial E] Trailer-'Court El Motel 0 Other D <br /> rig <br /> 'Lot size ..................... ....I ........ <br /> Number of living units: N u m ber-of,bedrooms Number of baths ---------- --- <br /> Water Supply: Public system 0 Community system [I Private ff/Depth To Water Table -------- ft. <br /> I k t: - <br /> Character of sail to a depth of 3 feet: Sand E] Gravel FSandy-Loam Kclay-�Loam P �;lay_o. Adobe [3 Hardpan 0 <br /> [I <br /> Previous Application Made: (if yes,dateNo D , Ni;;;�,Construction:. Yes E] No E] FHA/VA: Yes [I- <br /> No <br /> ' f —,q­,�., I .I( V .. �r U <br /> TYPE OF INSTALLATION AND SPECIFICATIONS. -i.I <br /> (No septic:fank.or cesspool permitted-if-public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well..-._...._._..-.Distance from foundation--------_----------Material------------------------------------------------ <br /> No. of compartments--------------------------size--------------------------------Liquid depth----_---------- ------.Capacity---------------'..--- <br /> DispXosR,Id: Distance from nearest well......;�tl_-_Distance from foundation-._... .....Distance to nearest lot <br /> Number of lines........../----------------------Length of each line....--------IF� ---.._...Width of trench.......#23...v................ <br /> Type of filte'r It materiaI_;iW1teA------.De pth of filter material------/Pr-------Total length-----JFA.........­.................. <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation.......------------Distance to nearest lot line_...-............ <br /> ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------,Depth--------------------------------- 0 <br /> Cesspool: Distance from nearest well.................Distance from foundation--------------------Lining material------------------------------------- <br /> ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity--------------------------_gals. <br /> 'Privy: Distance from nearest well..._-.__................._-.-.-----------------Distance from nearest building.----.-.-.._.-----_..___-_--.--.---------. <br /> Distance <br /> uilding------------------------------------------ <br /> Distanceto nearest lot line------------------------------------------------ •------------------__------------------••------------------------------------------------- <br /> Remr repairing (describe):--------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ----------­------------------------------------------------------------------------------------------------ -------------------------------------------- -----------------------------------------------------------------C;X <br /> ------------------------- ------------------------------------------------------------------------------------------------­­----------------------------- -------- --------------•---- -----•-.....-•--------------------- ----------------------------------------------------I-------------------------------------------------------------------- <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) ws, and rules and regulations of the San Joaquin Local Health District. <br /> l <br /> (Signed}------- -- ---------------- ---- - ------ -------------------------------L-------------------------------------------•------------------`i�nc/or Contractor) <br /> --------- - ... ----------------------------------------------------------(Title)---------------------------- <br /> (Plot plan, showing size of lot. I cefin of stem in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY.. ----------------------------------•------------------------ DATE__/�__Z�0'----Y•-------------------------- <br /> REVIEWED <br /> '------------------------------------- <br /> REVIEWEDBY-------------------------------- ----------------------------------------- ---------------------------------------------_-- DATE----------------- ------------------------------------------ <br /> BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE---------------------•--------------------------------------- <br /> Alterationsand/or-recommendations----------------------------------------I------------------------------------------------------------------------------------------------------------------ <br /> -------I......1-1....................... ----------------------------------------------------------------------------------------I-----------------------------------_------------------I------------------------------ <br /> ---------------------------------------------------------------- ------------------------------------------------ ­--------------------­----------------------------------------------------- --------------------------- <br /> ---------- -------------------- -------------------------------------- -------------------------- ---------------------------------.....--------......-------•---........------------. ---------I-------------- <br /> ----------------------- <br /> -------­­----------_-_----------- ---------------------------- -------- --__-------------------------------------- -------------------------------------------------------__. <br /> Date. -/,?-:-6 y-------------•----------------------------------- <br /> FINAL INSPECTION BY:- <br /> D <br /> .11,;&.1-4 - ---------_---------------- - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 134 Sycamore Street 205 West 91h Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 8-59 2M 5-62 ATLAS <br />