Laserfiche WebLink
APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) <br /> Date Issued --- .12� <br /> Pt3- 130 ­0-, <br /> Applica4-ion is hereby made to the ')an 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. SY <br /> ' <br /> t <br /> JOB ADDRESS AND LOCATION---- 1�----------------- <br /> Owner's Name---- - <br /> ------------------ ---- - ------------------ ------------------ Phone-•------------- <br /> Address----------------------- - --------------- <br /> Contractor's Name­.,��. <br /> ------ -------- <br /> -- -- --------- --------------------------------------------------------------------------------------------- PhoneAV--,.5-7z-4-Ls- <br /> Installation will serve: Residence Ra-Apwfmenf House [j Commercial'- E] Trailer Court [] Motel E] Other E] <br /> 1,..-Number of living units: ,--- Number of bedrooms Number of baths -1 <br /> ---- Lot size -�tv----- <br /> Wafer Supply: Public system El Community system [I Private 4-.Rlpfh fo'Water Table IR ff. <br /> Character of soil to a depth of 3 feet: Sand Sandy Loama' <br /> El Clay Loam [] Clay E] Adobe E] Hardpan E] <br /> Previous'Application Made: Yes E] > N6tfA---M'&w Construction: Yes <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic,Tank- Distance from nearest <br /> t well.L:�v-------Distance from foundation-- Maferia I---- <br /> 0., No. of compartments.-----�--------- ---Size--<M--- ----Liquid depth--- ----------Capacity---- <br /> Disp I Field: Distance from nearest welf-t�70- '------D'�stance from foundation---/P ------Distance to nearest lot line--- <br /> LaL Number of lines------/........... <br /> .................Length of each line.....S-V-------------------Width of trench- <br /> T I <br /> Pit; Type of filter material.­/­<-----------Depth of filfecr material....1(:5- -Total lengfh---,?-.P------------------ <br /> See Distance to nearest well-__10V---------Distance f <br /> kom foundation_-. Distance to neares <br /> Zr.,T Number of pits----..-------------Lining material__AU-.4nwv4<,-Size: Diameter/./P-l'-- <br /> -----Depth-- --- ------ <br /> Cesspool: ,,Distance-from nearest well-----------------Distance from foundation---------------- ---Lining material <br /> ------------------------- <br /> Size: Diameter Liquid- Capacity---,.------------------------ <br /> Privy: Distance from nearest well-------------------------------------- ---------Di5itance from­nearest building-----____-__-___----------_Distance to nearest lot line- ' A <br /> --------------------------------------------------------------------------------------------------------------------------- <br /> Remodeling and/or repairing (describe):-----------------------------------------­1--------------------------------------------------------- <br /> I <br /> ------------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------- I----------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------- ------ --- <br /> -------------------------- --------•-----------•--- -------------------- ­------------------------------------------------------------ --------------------------------------------------------------------- <br /> I hereby certify that I have.preparedthis 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)---A- 64--Ao-;�& I <br /> ------ ------- ------------------ ------------------------------------------------ -----------(Qw"r-an44or Contractor) <br /> BI-------------------------------- <br /> -------------------------------------------(Title)------.----- <br /> -- - ----------------- -------------------------------- <br /> (Plot plan, showing size of lot, locafio6 of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED ------ ---------------------------------- ---------------------------------------- DATE <br /> ------------- -------------I WED BY--------------------- --------�i ,...... --- ---------------------- : --------------- ------------------------- DATE—...-;61-1 <br /> BUILDINGPERMIT ISSUED-----------------t-------------- ------------------------------------------------------- ------------- DATE--------4` <br /> ,IPA <br /> Alterations and/or recommendations:------- ------------ <br /> ----------- <br /> -------------- ---------------------------------------------- <br /> ---------------------------------------------­----- <br /> -------------------------------------------------------------­;-------------------------- -------------- ------------------- -------------------------------------I---------I-----------I-------:------------------ <br /> ------------------------------------ -------------------------------- P <br /> ------------- -----------------------------------------------­ ---------------------------------------- .......— - A .. <br /> ------------------------------------------------- --------------------j I ­------------------- ------ <br /> - - ----------------------------------------------- --------------------- <br /> ------------- -----------------------------------------------------7" <br /> FINAL INSPECTIONBy:------- ------------------------------- Date------- <br /> ... ... ........ ------------------------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North ­C­ Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br />