Laserfiche WebLink
r A. <br /> APPLICATION FOR SANITATION PERMIT Permit No. -_9!3.7________ <br /> ' <br /> V�,vith <br /> y U� (Complete in Duplicate) $ <br /> Date issued <br /> Applica{ion is hereby to thein Local Health District for a permit to construct and install the work herein described, <br /> his application is made in compliaounty Ordi nce No. 549. <br /> JOB ADDRESS AND LOCATION.. � `- ------d." __-"-------------- - <br /> L G <br /> Owner's Name -�Y. ' _k_------- ------ --------------------- Phone_A-_ ---- --- <br /> : . <br /> Address. <br /> (� <br /> Contractor's Nameh� '`4'v44-. ------------------- <br /> rice <br /> ---------------- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court 0 Motel`❑ Other ❑ <br /> Number of living units: __l!__"__ Number of bedrooms j__ Number of baths J---- Lot size ___ ___]�- <br /> ----------------------------------------- <br /> Water Supply: Public system [Community system El Private I-] .Depth to Water Table 4' ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay.Loam ❑ Clay ❑ Adobe ErHardpan ❑ <br /> Previous Application Made: Yes ❑ No E4'- New Constructi`orr:.,Yes.2" 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-------------------Distance`from foundation------------- Material----------------------------------------______"_. <br /> No. of compartments-. - - ' Size--------------------------------Liquid depth----------------I---------Capacity-----------•---------__ <br /> Disposal I i I Distance from nearest well_______ Distance from foundation--------------------Distance to nearest lot line_________________ <br /> Number of lines------------ ----------------------Length of each line-------------------------------Width of french---------------------. <br /> ------------- <br /> Type of filter material--------------- -------Depth of filter material ,_-_.- Total length_______________________ _________-------- <br /> Seepage, <br /> _____-- <br /> See a e,Pit: Distance to nearest well____- __ - Distance from foundation__/0-_-__-____.Di tance to nearest lot k e__`�_______.-_ <br /> p 9 - - <br /> Number of pits____f________________Lining material_ _____.__.Size: Diameter__--_-4a'+.____Depth.-.-Z�� <br /> ------------------- <br /> Cesspool: Distance frominearest well-----------------Distance from foundation--------------------Lining material------------------ -__-___________-_ <br /> l <br /> to-N! Diameter----------------- ---- ----- - ---- Depth-..--------------------•------ ---- -- -- ------Liquid Capacity-------------- _-------•--gals' <br /> 1,erivy: ' Distance from <br /> Inearest9 ------------------------------ --------------.Distance from nearest building"_--__-__"__-_____-______-_----.- <br /> ❑ Distance to nearest lot line ------- - -----------•--------------------------- . ---------------------------- ---­--------------------- <br /> --------------------- <br /> --. --------------------- <br /> Remodeling n r rep ' in [describe]: ------------- ------ ----- `------ <br /> ----- ------------- . <br /> ------------------ <br /> ------------------------------------ <br /> ---•- ---------------------------------------- <br /> T <br /> ________"_.- ---____:______________-____.__________________________________________________________________________________---__-:_____-_---____________-"____"_______--__-__"---__ <br /> I hereby certify thaf 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 /> s"____ Owner and/or Contractor <br /> (Signed)------ ------- -------- ----•---------- �- --------- - - - - - f -------- ------ ( � } <br /> sy--------=-----_� --- ----- - - -----•�-• �--------=---------------=-----°===:�===•--= ------=----------------(Title 1----- _-l-rii:-�--- ----------------"--- <br /> (Plot plan. showing size ot, location of system in relation to wells, buildings, etc., can be placed:on reverse e]. <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ------- -- -- --- ------------------ ---------- DATE--- ------------- <br /> REVIEWI D BY = -- - -----` � - DATE �`� - ----`-"---�---•----- <br /> -- -- --- -------------- ----------- <br /> BUILDING PERMIT ISSUED------------`--- _ __.--- -- -- - <br /> 1 _ ----------------------------------- ------ DATE--------------------------------------- -- -------•-------- <br /> Alterat ns and/or recommendations:_-..__. �.- _. "_ -fi =--- -----____-- r A t--------------------------- <br /> ftl <br /> eO <br /> ---- •-- -- F ----- ------------ <br /> - <br /> W <br /> r � <br /> -- - ---- <br /> -- _ _ <br /> ---- - _.-.. - -- ---------------------------------•--- -- --------------------------_ ------- <br /> � '"", FfNA� INSPECTION BY::,�: .t.- - - �' .-.� -----=------------------ Date. �.----•-- --------------------------------- <br /> SAN <br /> -- -- <br /> SAN JOAQUIN LOCAL HEALTH'DISTRICT <br /> 130 South Amerie'an Street 300 West Oak Street 132 Sycamore Street 014 North "C" Street <br /> Stockton, California Lodi, California Manteca,-California Tracy,. California <br /> � iasace aTwaov <br />