Laserfiche WebLink
Metadata
Document management portal powered by Laserfiche WebLink 9 © 1998-2015 Laserfiche. All rights reserved.
-� F,012 OFFICE U§€: <br />------------- <br /> -_.'._--------------------------- 13APPLICATION FOR SANITATION PERMIT Permit No. ..f�, 7. <br />------------------- ---------------------- ------- (Complete in Duplicate) iL�� Date Issued .-,7 '1��3 <br />---------------------------------- This Permit Expires 1 Year From Date Issued "1 <br /> Application is hereby made to the San Joaquin Local Healt strict for a permit to construct and insta the work herein described. <br /> This application is made in compliance with County Ordin a No. 17, <br /> 4z�141_4, <br /> JOB ADD ND LOCATIO __.��f m ________.... <br /> r = <br /> Owner's Name- •- -- -- ----- ------- .... - ------------------------------------------ Phone.................................... <br /> Address. .---•----------------- - <br /> Contractor's Name. C�.. .- _b T-- �-•-- .1 -Y�....-• F . Phone.._ .. . .... <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units-014- Number of bedrooms Number of baths c2_,, <br /> .. Lot size .__. .._ r_�_ .t�,.0 <br /> Water Supply: Public system ��,OmmunitY system ❑ Private ❑ Depth To Water Table .�61t. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ obe ardpan ❑ <br /> Previous Application Made: (If yes,date____________________) No E] New Construction: Yes [:] No FHA/VA: Yes ❑ No ❑ <br /> OF INSTALLATION AND SPECIFICATIONS: N <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 6I-x , .1? %**� <br /> Se 'c T Distance from nearest well-----------------Distance from foundation....................Material--- .. 1 ........----- <br /> � No. of compartments-------_________ _________Size................................Liquid depth___--..-______.-.___-_---_Capacity_s_. �. <br /> eld: Distance from nearest well.��Distance from foundation---/ ........Distance to nearest lot line------ <br /> Number of lines... .____ ____. __._. Length of each line_ Width of trench._._ .r•.�_._`.-!......... <br /> Type of filter material1 _.Depth of filter material..-/.__fes'�......Total length.... ^ '................. <br /> See e Pit: Distance to nearest well_M_G►_14_9--__-_Distance rom foundation___•-_�_Q____.Dist nearest lot line____..__ <br /> Number of pits----lj_____--__---__-Lining material._ 111111 _ _ ------Size: Diameter---�.I-_._.._..Depth----- . <br /> Cesspool: Distance from nearest well-------------_---Distance fro oundation----------.---------Lining material.................................. <br /> ❑ Size: Diameter--------------------------------------Depth-------•--------------------------------------------Liquid Capacity............................ga <br /> Privy: Distance from nearest well-----------------------------------_____________Distance from nearest building.......................................... <br /> ❑ Distance to nearest lot line----------------------------------------------------------•--------------------------------•-•------------•--•---••-•------------------------- <br /> Remodeling and/or repairing (describe)---------- ------ ----------------- <br /> - -- - <br /> ---- ---- - -- -- -- <br /> f <br /> --------------------------- ............................................. ... ......; -yk�-------------------- ....*------------------- -----------------------*------------------------------------ <br /> •--•-------------------•---•------------------•-------------•----------•------- --------------- ---I---------------------------------------------------•----------------------------•-------------- -----------------•- — <br /> I hereby certify that I ve prepared Is application and that the work will be done in accordance with San Joaquin County <br /> ordinances, ales d re tions of the San Jo uin Local ealt rict. <br /> (Signed) -•---•._.......•--•--•-••• --------- ---- - -� � ------- ---------------------•----------- •.....(�r-Contractor) <br /> By:................................. <br /> .............. ------------------------- ----- - !- ..........lTitle)---------------------------------------------- - ---- --------- <br /> (Plot plan, showing size of lot, location of system in relation t wells,tuildings, c., c n be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------------ ----s-- -------------- -- --------------------------------------- DATE----7 ... ............................ <br /> REVIEWEDBY----- ----- ............................................ DATE............................................................ <br /> BUILDINGPERMIT ISSUED.............................. .........................._------------------------------------- DATE............................................................. <br /> Alterations and/or recommendations:.___.._.._ ................... <br /> -- ----- - ----------------------------------- <br /> --•----------------------`7= ` -,-3----- --- --- ------•-- .... - <br /> ---7-- �-------a---.--- - c <br /> .--- <br /> ..-•-•-•----••-----•------------------------------••---•---•---- ------------------------------------------- ."- <br /> ---------------------------------------- - ---------------•--....------ . --•------- ------------------------------------------------------------- ---------•-------•----------.. .......................................... <br /> FINAL INSPECTION BY:.-.------en...� --------------------------- Date....... &-- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 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 2M 5-62 ATLAS <br />