Laserfiche WebLink
FOR OFFICE USE: <br /> ------------------- ----------------------------------- <br /> ------------------------------------- ------------------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. _J(Complete in Duplicate) <br /> Date Issued ........... .. <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. 549. <br /> JOB ADDRESS AND LOCATION.............a---- <br /> __727. .1(2.*--------A. .................................................... ................... <br /> Owner's Name-------------------I--------------------W.e ge I <br /> ........................................... ------------------------------------------- Phone.................................... <br /> Address.................................... ----------------------------------------------------------------------------------------------------------------------------------------------------- <br /> Contractor's Name--------------------- ------------------------------------------------------------------.................................... Phone................................... <br /> Installation will serve: Residence g Apartment House E] Commercial E] Trailer 11W R Motel ❑ Other [I <br /> Number of living units: Number of bedrooms ........ Number of baths ........ Lot size ........#476.......V...... <br /> - li(_y.................. <br /> Water Supply: Public system [X Community system [-] Private E] Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel [-] Sandy Loam E] Clay Loam E] Clay [3 Adobe' Hardpan 0 <br /> Previous Application Made: (If yes,date._-___.__._____-.) No E] New Construction: Yes [-] No E] FHA/VA: Yes El No n <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Se* Tank: Distance from nearest well-_-------------Distance from foundation--------------------Material_.............................................. <br /> 7c-, No. of compartments---_---------------------Size----------------...............Liquid clepth---_--------------------Capacity_---------_-------- <br /> D'Snouasal -eld: Distance from nearest well-----------------Distance from foundation....................Distance to nearest lot line.._..._.......... <br /> (�1_4 Number of lines-----------------------------------Length of each line------------------------------Width of trench------------------------------------- cl� <br /> Type of filter material-------------------------Depth of filter material----------------------Total length_.__....._....._.............._......._... 'Ilk <br /> Seqp,age Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line.................. <br /> uqyj__� Number of pits______________________Lining material-_--------------------Size: Diameter._-_-__-...__-.-_------Depth--------------------------------- <br /> CesspooY 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 /> 1-1 Distance to nearest lot line----------------------------------------------- ..............................................................................._------------ <br /> Remodeling and/or repairing (describe --------- e_A -----ctn----14Ael.-I---- a S- <br /> j............... <br /> ------------------­---- --------- it--to-ve fz_;�----A_I.A ---- --I,% 1c, ---------------------------- <br /> F_ 0A1 <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 /> ordinance,, State ws, a d rules and regulations of the San Joaquin Local Health District. <br /> --- <br /> (Signed)... -- -------------------------------------- ------------------------------------------------------------------------------ (Owner and/or Contractor) <br /> - <br /> By:------------------------------------------------------------------------------------------------------------------------------------(rifle)-----------------------------------_- ...... ---------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPAU ENT USE ONLY <br /> APPLICATION ACCEPTED -17')------------------------------------------ DATE....... —.-(r ----------------- <br /> REVIEWEDBY-------------------------------------------I -------------------I----------------------------------------------------------- DATE............................................................ <br /> BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE--------.................................................... <br /> Alterations and/or recommendations:............................................................................................................................................................... <br /> -----------------------------------------------------------------------------------------------------I-------------------------------------------........................................................................... <br /> ---------------- ------------------------------------------------------ ------------------- ............................................................................................................................. <br /> ................ -------------------------------- -----------------------------------------------------------­-----I........................................................................................................ <br /> -------------------- -------------- ----------------------------------------------------------------..................................................................................................------------ <br /> ---------------- Date------2? --------------------------­-I.............. <br /> FINAL INSPECTION BY: <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 /> E9-9 REVISED 8-59 F.P.00.2M 6-60 <br />