Laserfiche WebLink
Metadata
Document management portal powered by Laserfiche WebLink 9 © 1998-2015 Laserfiche. All rights reserved.
71Z <br /> OFFICE <br /> l <br /> y <br /> .... ______...__ f APPLICATION FOR SANITATION PERMIT Permit No. ...... <br /> ---- l � -..__ <br />-- ------ --------------- - (Complete in Duplicate) °� <br /> w r Date Issued-''_--_-•---_---. <br /> -- 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 /> a This application is made in compliance with County Ordinance No. 549. ` <br /> JOB ADDRESS AND LO TION- ---------�:<YKO------- -•--------------•------------------------------------------- <br />:5 - <br /> Owner's Name - - - ------------- Phone------------------------------------ <br /> Address �- <br /> Contractor's Name _ 'i. -------°-----•--------------------------- Phone_ s �� � <br /> Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: 1"'-Number• of bedroom_-- Number of baths . ____ Lot size -___t r , �__________________ <br /> Water Supply: Public system Community system ❑ 'Private ❑ Depth to Water Table -------- ft. <br /> Character of soil to'a depth of 3 feet: Sand ❑ Gravel ❑ "Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobeo Hardpan ❑ <br /> Previous Applications Made: [If -- <br /> -------- <br /> yes,date--- - ------) No New Co struction: Yes ❑ No FHA/VA: Yes ❑ Nox <br /> �. <br /> TYPE OF INSTALLATION' AND iSPEC IFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) - <br /> ... <br /> Septic Tank- Distance from nearest well-----------------Distance from foundation----------------_---Material----------------`___ <br /> ---------------------------- <br /> ❑ No. ofcompartments--------------------------Size----------"----- ----------------Liquid depth.........:.,..............Capacity-------4 <br /> Disposal Fiel : :Distance from neare"st•well'24?~_Distance from foundation.._•/Q_____.___Distance to nearest lot line_�________ <br /> ,. <br /> Number of lines___________ __ � ,{�.- <br /> ____._. _ Length of each line__________ [3______._.Width of trench____._ _ _ <br /> ,Type of filter materra1_! ____Depth of filter material______ ��__Total length________________ �f <br /> F ir I / 4"_ ---I_____ W <br /> See ane it; Distance to nearest well-- --_Distance f om fo ndation_____dC'____..Distance to nearest lot.line___.Ji__._..____ <br /> it; <br /> of pits------- -------Lining material__ p <br /> _.Size: Diameter_____ a._� { <br /> �� � - - -De th-------def`----=------- -• <br /> Cesspool: Distance from nearest well __________.,_Distance from foundation_.________.______.Lining material_____________________________________ 2 <br /> ❑ .YP 4 Liquid Capacity_-------------------------gals. <br /> Size: Diameter--------'------------ ------- -------De th=----------------------------- <br /> Privy: j Distance,from..nearest.well---------------- <br /> -=----=- -----Distance.fro.m. ,nearest:building------------------------------------------ <br />' ❑ IDistance to nearest lot line- ------------ -- ---------------------------�---------------------------' <br /> 1 I - <br /> Remodeling a or repair- g;[de ibe]:___ � -- ____ -�cp�¢� _ <br /> POW <br /> * fs <br /> r - =_ <br /> y -------------•--------------••--- -----+-----k--:----------------•----------------`----------------------------7----------a- <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 r gulations of the San Joaquin Local Health District. <br /> (Signed)- # /�� - ---------------- •------------------------------------7 (Own and/or Contractor) <br /> gY• - ; -------- <br /> ------------(Title)_- <br /> (Plot plan, showing'size'of:.lot;,location of. sfem.in,relation,to wells„buildings,,etc., can 6e placed on reverse side). Y <br /> r • <br /> { FOR DEPARTMENT USE ONLY . } <br /> APPLICATION ACCEPTED BYA.----�(.�------ -- I I <br /> DATE <br /> REVIEWED BY------•.I---------------- ------------------------------ <br /> I --------------------I DATE___ _ . <br /> BUILDING PERMIT ISSUED----, ` --------'------- DATE <br /> r. 7 . ------- Y , <br /> i Alterations and/or recommendations:____? � � : -{�- <br /> ` _ y ..—s_ _�J --------------•--------- - <br /> -�.-�`_ cn" - •---•------ - --------- ` --------------------------------------•-------------- <br /> ___________________________________ _ _______________________________________ ___ __ - y <br /> • 4__ __ _ ___________________________________..__{._.__.___.______._____-_________-____ ...___..__.__ <br /> _______________________________ i.. - } _------------ <br /> --------------------------------------------------- <br /> ___________ <br /> e E <br /> --------------------------------------- <br /> -------------------------------------- __._ ..__ <br /> FINAL INSPECTION BY:...__ ------ --- ------------------------------------ Date--------------------/----- <br /> Ilk <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hasellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th street <br />' Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED B-59 3M 3-•63 F,p,CO. ' <br />