Laserfiche WebLink
n PPLICATION FOR SANITATION PERMIT Permit No. .0t. <br /> (Complete in Duplicate) J <br /> /01 1 This Permit Expires 1 Year From Date Issued Date Issued .__�_b_r.3_` ° <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. 1 <br /> JOS ADDRESS AND CATION__ ._ _-_�_ ��_____�. ____ :.�' . � <br /> lsf-� ---------------- l <br />< Owner's Name---- �X1.----- -------------------------------------------------------------------- - ---._. Phone---------------y----------------- <br /> Address -------- ---------------------------••-----"-•-------=-----------------------------------------------------_---- ---...-.---_-------------------­ <br /> - <br /> -- -- _--: <br /> Contractor's Name------------ -- ---- - ----<`' "-`-"- -----------------" Phone...- <br /> a <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __Z__ Number of bedrooms __iZ_ Number of baths f Lot size ._ - /' .........................-.__.___._ <br /> Water Supply: Public system ❑ Community system Fr-P'rivate ❑ Depth to Water Table -FA ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> Previous Application Made: Yes ❑ No New Construction: Ye, P--`No-,0 FHA/VA: Yes ®�No.❑ <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�------ <br /> c.._-------Distance from/f,oundation__ ---------- I____���- __ -___ ____ __...._...... <br /> No. of compartments____ ?.................Size_ x,'Is X Liquid depth_' -�____-_.Capacity__ i __. <br /> Disposal Field: ' Distance from nearest well____--'� --------Distance from foundatio Distance to nearest lot line---+0----_-__. <br /> of lines----------- .__ Length of each line".____ Width of trench___.e ___ ___________------------ <br /> Number <br /> y d� <br />€ Type of filter material__- �L6> Depth of filter material____. ___.__.__Total leng#h_- - ___------------------- <br /> Dist <br /> --___""-"___-.__ <br /> Seepage Pit: Distance to nearest well77=--___Distance from foun ation-_-_��_.__.___D stance to nearest lot lin�___ ___.._.._ k <br /> ' Number of pits--.--�-------"-__Lining material----AP��Size: Diameter---�-------- Depth_.A.;p-_.__-._----..___.__ <br /> Cesspool: Distance from nearest well_________________Distance from foundation--------------------- material_-..--______-__"___.-__.____.___ <br /> k - ` <br /> Privy; Distance D stanDc€e fromr nearest well.____.___ _____Depth__ ___._.__ !-Distance from nearest lbui dingcity-.--_---r`-------------------gals. i <br /> ❑ Distance to nearest lot line---- - --- - ----------------------------------- - - •-------------------------------------------------------- <br /># Remodeing and/or repa€ryng (describe):s,._____.__- --� -- � � �+ ----------------------------------------------- ------ <br /> I <br /> ------------------•-••-----------------•--------------------------------------•---•--------------------------•-------------------------------------- --------------------------- , ------------------- <br /> 1 F ' _ i fr ------- ------------"_"- <br /> 1 -------•----------------------------------------- <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, a drules and regulations of the San Joaquin Local Health District. <br /> ~ <br /> i -- # 'map <br /> {Signed}----------- - -- -- ---------------------- -- ---------------------- --- ( r Contractor <br /> -- { <br /> ) <br /> r a <br /> By•---------- ------------------------------------------ --- ---------------------------- (Title) <br /> (Plot plan, showing size of lot, location o stem in relation to wells, buildings, etc., 6n be placed on reverse side). <br /> i <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----------------------5 ' •- -------------------------- DATE--'- -0,` `rs-€------------------------ <br /> REVIEWEDBY----------------------------------- --------------------- --------- --------------------------------------- DATE---------------- =`--------------------------------------- <br /> BUILDINGPERMIT ISSUED-------------------------------------._...----------------------------------------------------------- DATE-------------------- ------------------------------•---- -- <br /> Alterationsand/or recommendations:-------------------=------------------------------------------------------------------------------- -----------•--•-------------------------------------------- <br /> ----------------------------I <br /> ------•----------------------------•-----•-•------------------• ----------------------•----------------------- -----------------------------------------------------------------------------------------------------------------•-------------------------- <br /> ----------------------•---------------------------•------------------------------•-------------------- ---------------------------------------------------- ---------------------------------------------•------------------- <br /> FINAL INSPECTION BY:. - -- - ------------------- -------G---d---- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street , 1,32"Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, Californias"+ Manteca, California Tracy, California <br /> l FS-9-2M Revised 8-'59 F.P,Co. - <br />