Laserfiche WebLink
FOR OFFICE USE: <br /> --------------------------------------------------------- <br /> ----------------- ------------ - ----------I -------- APPLICATION F611 SANITATION PERMIT Permit No. <br /> ----------- ----------- <br /> --------- --------- (Complete-in Duplicate) Date Issued <br /> ------------- ­­ -- ----- --------------­ I 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 /> d 4 - <br /> JOB ADDRESS AN qO <br /> CATION 11 —0. <br /> Owner's Namee� ...... <br /> ------Z-.-/.14/ -------------------------------------- --------- -- ------------------------ ------ Phone.................................... <br /> f <br /> ,Address................................3.94--- 4---- .......................................................... ........................................... <br /> Contractor's Name......................... . ........ ------------------ ----------------------------------------------- Phone--- <br /> -_ � 0_,�------ ............................... <br /> - . <br /> Installation will serve: Residence Apartment House E] Commercial [] Trailer Court C] Motel E] Other ❑ <br /> Number of living units: Number of bedrooms Number of baths -a Lot size -------- -- x...... -S---.._--._ <br /> Water <br /> S----------- <br /> Water Supply; Public system E] Community system 171 Private E] Depth to Water Table ------ - ft <br /> Character of soil to a depth of 3 feet- Sand F] Gravel F] Sandy Loam [] Clay FHA/VA: Yes No Loam El y [:] Adobe[] Hardpan-a <br /> No E] E�'� <br /> Previous Application Made: (If yes,date_--- ._._.....-_'_ ) No New Construction: Yes ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS:� <br /> No septic tank or cesspool permitted if pu6lk sewer is available within 200 feet.) <br /> Septic T Distance from nearest well..45-V!----Dist f f d t' ..m erial <br /> PC , Siz rce T7 (i;3 7; --- -------------------------------- <br /> 11 No. of compartments...-_....7j ------ -Liquid depth._. ...YZ-—- ------- Capacity.... <br /> e _q <br /> ion <br /> Disposal ield: Distance from nea rest well._40.�------Distance from founclationlO Distance to nearest lot 11 e,.e;�_ <br /> 4 13_ --- lot <br /> of lines...... Length of each line-- Pii-01 Width of trench ----------- <br /> IA,__,k------------ do <br /> Type of filter material.--- _72__.__)W_Ckbepth of filter material___.[: ----Total length__-- k.11 -1.. <br /> Seepage Pit: Distance to nearest Distance from foundation....................Distance to nearest lot line----------------- <br /> F1 Number of pits...------------------Lining material-_----.-..._--.------ Size: Diameter-___-....._--_-----.Depth-__-.-_._ ------ <br /> Cesspool: Distance from nearest well ----------------Distance from foundation.-............... ..Lining material------------------------------ ....... <br /> 1-1 Size: Diameter- -- ---------- ----- ----------------Depth---------------------------------------------------Liquid Capacity-_---------------------...gals. <br /> Privy: Distance from nearest well_.... -------- ------------------ ---------Distance from nearest building------------------------------------------ <br /> ❑ Distance to nearest lot line.-------------------------- ------ ------------------------------------------------------------------------Z <br /> - e - <br /> Remodeling and/or repairing (describe):------------ ------ ---- - -- ----- ------------- - -- ------------- <br /> ---------- -I./-------_------------- <br /> ------ ----------- ----_------------------------------------------ <br /> --------------------------------------------------------------­-----­--­---- ------- --------- --------- <br /> -----------------I--------­------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------ <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 /> ordinances, Sta s, and rules ajW, re?ulations of the San Joaquin Local Health District. <br /> " �1 ) 450-- 1, <br /> (Signed)---------------- ------------- -------- ------------------------- ......:.,.-.(Owner and/or Contractor) <br /> ------ ------ <br /> By:..................... ... ...... . -----�-v-l-. ---_1--------- --------------------(Titl ------------------ <br /> (Plot plan, showing sSot, location o system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY 40Z <br /> APPLICATION ACCEPTED BY ---49*4�_ _ ---------------------------------------------------- DATE--_.1'/:�!YOZO <br /> REVIEWEDBY------------------------------- ---------- ------------- ------------------------------_---­---------------------- DATE.-..--.------------------------------------ <br /> BUILDING PERMIT ISSUED--------------------------------------------- ------------------------------------------------------ DATE----------- ---------------- <br /> Alterationsand/or recommendations------------------ ---------------------- -----------------------------------------------------------------------.....................------------------------------------ ------------------------------------------ -------------------------------- -------------------------------------------- ---------------------- ......................................... <br /> ------------------------------------ ---------------I---------------- --------------­------------------------------------------------------------------------------------------------------ <br /> ­--------------- ------ --------------- ...............I------------- ...............I---------------------------------------- ---------------------- ---------------......... .... ........................... <br /> ------------------- ------------------------------------------------------- -------------------------------------- .................1-.-----------•----•-------------------------------------------- <br /> FINAL <br /> ............__--------------------------------------------- <br /> FINAL INSPECTION BY:..4 -----_--------------- Date--....4�_J_­------------­ ------------------------------------------ <br /> SAN <br /> --------__-------------------------- <br /> SAN JOAQUIN LOCAL HEALTH, DISTRICT <br /> 1601 E.Naulton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi, California Manteca,California Tracy,California <br /> E.H.9 2M 1-67 Vanguard Press <br />