Laserfiche WebLink
Metadata
Document management portal powered by Laserfiche WebLink 9 © 1998-2015 Laserfiche. All rights reserved.
� APPLICATION FOR SANITATION PERMIT Permit No. <br /> r` lic�te Com late in Du <br /> { P w _Duplicate) :. Date-Issued <br /> ' U\ Application is hereby made to the San Joaquin Local Health'D'rstrict for a permit to constr ct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION_'` - -------- <br /> J <br /> Owner's Name 1�_�l-9 LLr'r� --------------0-AI--4----------- Phone,S�Q O_13 �Y--"--- <br /> Address___' <br /> fl�Contractor's Name_z--------------------------- ---------------C_A )AIA 7 Phone. <br /> --- <br /> Installation wserve: Residence V Apartment House ❑ Commercial ❑ Trailer Court <br /> ' � Itlltiill <br /> ❑ Motel ❑ Other ❑ <br /> Number of living units: ____ Number of bedrooms A Number of baths ---t-_- Lot size ___-ZO---._?4 ______________ _------ <br /> Water <br /> __ <br /> Water Supply: Public systerri� • Community stem ; + <br /> -(� y y ❑ Private [� Depth to Water Table '�� ft. <br /> Character of soil to a depth of 3 fee Sand 1 <br /> p ❑ Gravel ❑ Sandy Loam Clay Loam [❑ Clay ❑ Adobe[Hardpan ❑ <br /> Previous Application Made: Yes❑ No [v� New Construction: Yes [!I/No ❑ FHA/VA: Yes ❑ No 0� # <br /> TYPE OF INSTALLATION AND 07SPECIFICATIONS: <br /> j (No septic tank or'cesspJl pe4mit+ed if public sewer is available within 204 feet.) <br /> p E)O0N4 No. of compartments-------------- ----------Size----------------------------.-Liquid depth----------------.----------Capacity----------- } <br /> f Septic Tank: Distance from nearest well_______________ -- -. <br /> Distance from foundation_..:___ __ <br /> - Material_____________�-.- <br /> k �, � <br /> Dispos I Field: Distance from nearest well___ ?�1___._Distance from foundation___fQ_---------Distance to nearest lot line______..__. <br /> 7 Number of,lines_-� ;�j '_ ______Length of each line---------- _________.Width of trench._________'__ <br /> Type or filter materiai___ C t' ._.__Depth of filter material___ -----Total length---------/_0�_o---- T__-.,,, <br /> Seepage Pit: Distance to nearest well:'________________s!D,istance from foundation--------------.----Distance to nearest lot line----------------- <br /> ❑ p' ______Lining material______._____:_._.____.Size: Diameter______________________ _ <br /> • .k , _` Number of its---- - ----- -Depth----- -----------•---------- <br /> Cesspool: <br /> --- ---Cesspool: Distance from nearest well-----------------Distance from,foundation_-_----------------Lining material______..___________________-____'# '" <br /> ❑ jSize: Diameter------------------------ Qep4h---------- ► -------------Liquid Capacity-.--------------------------gals. <br /> .;-------------- <br /> } Privy: Distance from nearest well-------------------------- ---------- -----Distance from nearest building------.----------------------_- -----. <br /> F ❑ Distance to nearest lot line = - -------------------------------•-------------- •-------------------- --""� <br /> i <br /> FRemodeling ancI or repairing describe :_____ F (* <br /> ----i---------•- --- -----/ � 'C 1f�R---------•,1-----------------•---------------------------------- -------------•----------------------- - <br /> ! --- i r <br /> ------------------------ ----- <br /> ------------------------1--- <br /> ---------------------- ------------------------- <br /> I... ----- --•------ _' D_t a� ------�----- /�1_�.. c�_r�_1�----- I �� Ia�1,�y.__../�II�ST----f '" �' T <br /> hereby:'cer+ify Aaf I have prepared this application and that the work will be done in accordance with San Joaquin County 1 <br /> ordinances, State,laws, and rules d regulations of the San Joaquin Local Health District. <br /> t` (Signed}------ ----------------------.---.--------------------------------.----------------•------------------(Owner and/or Contractor) <br /> By=-----------------------------------------------------------------------------------------------------------------------------------(Title)------------------------------------------------------------ <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> ,,.; ... «�F�}R DEPARTMENT USE ONLY <br /> S <br /> APPLICATION ACCEPTED BY!-----•------- ------ -------------- ------------------------------ ---------•----------- DATE------------- <br /> REVIEWED BY: <br /> __ t <br /> ------------------------ ----------- --- ---- - ----------------------------------- ---------------------- DATE--------- --�r-"-]------------------------- <br /> BUILDING PERMIT ISSUED---- •-------- ----- ------ --------------------------= <br /> - 4 DATE <br /> ---; - <br /> Al ------------------ <br /> +=aat'ons and/orQrecommend +ions --- ----- ---------- --- <br /> -------------------------•--- <br /> ----�- ----------------------------------------------------------------- <br /> ._. _. . G� S.. __ _��.--•-- <br /> --------------- <br /> NAL INSPECTION BY::'------ -'--G` ---------------------------- Date----671,0 �_ <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 /> ' ES--9-2M Revised 1-57 F.P,CO. F `F <br />