Laserfiche WebLink
FOR OFF!4C USE: <br /> Iq <br /> ---- --------------------------------- <br /> _ <br /> ------------I------- ------------ APPLICATION FOR SANITATION PERMIT Permit No. .. .. <br /> --------------------4-7-10------------ (Complete in Duplicate) ;, <br /> -- <br /> ----- ----- ---- —- ----------­ I This Permit Expires I Year From Date Issued 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......�2,.6` <br /> ,17 <br /> ------------ A/ <br /> Owner's Name------&K2 <br /> Address----- �'Sif'�yir, <br /> ------------------------------------------ <br /> ddress------ <br /> ------------------------------------------- ---------------------------------------------------------------------------------••-•----• --••--...... .. <br /> Contractor's Name--------- - "P <br /> 0 <br /> -------d-we------------.................................... Phonez <br /> Installation will serve: Residence Apartment House E] Commercial F] Trailer Court E] Motel [I Other El <br /> Number of living units: ___/-__ Number of bedrooms J--- Number of baths __/---- Lot size ....../i....... 4.7.5________________ <br /> Water Supply: Public systemj/C— <br /> 7-1.11_ <br /> ,M Community system E] Private D�r Depth TO Water Table ft. <br /> Character of soil to a depth of 3 feet: Sand 0 Gravel E] Sandy Loam I-] Clay Loam [Z Clay F] Adobe eg Hardpan <br /> ❑ <br /> Previous Application Made: (If yes,date--_-----_-.---_--) NON New Construction: Yes [:] No Ej FHA/VA: Yes [:] NojR <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 well-----------------Distance from foundation--------------------Material--------------- <br /> 0 No. of compartments---------------------- ...Size----_----------------------...Liquid clepth--------------------------Capacity....................... <br /> Disposal Fie Ld:, Distance from nearest well- Distance from foundation....../ _r.....Distance to nearest lot line._.._.0--." <br /> Number of lines-------------Z------------------Length of each line----------�C!...._..-__..Width of trench-------_----- --------- <br /> Type of filter material._./-�Face�<--------Depth of filter material-__--_Z 'p------Total length.....................cS ............ <br /> Seepage Pit-, Distance to nearest well---Z;9-Z_7r--------Distance from foundation------/4 Distance to nearest lot line_.._.__,------- <br /> Number of Pits--------/_----------Lining material------�k�7-x-------Size: Diameter------!13----------Depth--------2:1---............... <br /> Cesspoof:Lef Distance from nearest well-----------------Distance from foundation--------------------Lining material-__._-__.______--_____.--_----_-----_- <br /> 0 Size: Diameter------------------------------------.-Depth----------------------------------------------------Liquid Capacity-..-------------------------gals. <br /> Privy: Distance from nearest well--.--_._--_.-----_--_--.-____----_.-_ -----Distance from nearest building----------------------------- <br /> Cl Distance to nearest lot line <br /> Remodeling and/or repairing (describe):-------- _•_-45;!t7��-Z<7------ <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 /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)------- ...... ------ ...... <br /> ------ -----------------!A-Zc---------------------------------------------------(Owner and/or Contractor) <br /> By:--------------�e----'----------c- ',I r.--�_ ._ Title)----- <br /> (Pl(Plot ---------(T -------- _-------------r........... -- ---- ------- <br /> ot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---- <br /> --- I-A------ -- --------------------------------- DATE....REVIEWED BY------------- -------------------------------- ----- <br /> I --------------------------------------------------------------------------- DATE............ -------------- <br /> BUILDINGPERMIT ISSUED------------------------ ------------------:----------------------------- ------------------ DATE-------------------------------------------------------------------------- <br /> Alterations and or re ommentions:-------- r ------- <br /> �A_ � <br /> ----------I--------­-------------------- C-,e <br /> -------------------- <br /> -I- 4i <br /> ..........................A- <br /> --------------- <br /> ------------------- ------­----------------------- ------------- <br /> --------------------- I------------------------------------------------------------------------------------------------ <br /> ------------------- -------------------- ------------- <br /> -----------1,.... -------------------------------------------------------------------------------------- ---------------------------- <br /> ----------- ----- - -- ---- ----- <br /> ..........skk _-6*4,4:5-------41,%di <br /> -------QC-4%4QHS1 <br /> FINAL INSPECTION BY------------------------------------- ----------------------- Date <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9-REVISED 8-59 2M 5-62 ATLAS ,oc� L/� <br />