Laserfiche WebLink
'°�►.,y FOR OFFICE U y <br /> APPLICATION FOR SANITATION PERMIT <br /> Permit No. <br /> ---------------- /,/ • <br /> {Complete in Duplicate} Date Issued e� _--- ---- d <br /> Application is hereby made +o the San Joaquin Loc <br /> [Z;3R1 _r A-v�- 1 This Permit Expires 1 Year From Date Issued <br /> al Health District for a permit to construct and install the work herein describe <br /> Tk;s application isade in compliance with County Ordin4n,ce No. 549. <br /> ,....,. .. _ Pot ----------- <br /> r <br /> Vi1 <br /> JOB ADDRESS AND"LOCATION _______________ <br /> Owner ---------------- Phone <br /> s Name --- -----114?'ly�_Q - = 4 - - <br /> ---� n <br /> 0y, ---- -1l0b - D ----------------------- <br /> ------ <br /> ------- <br /> Address}or's Name-- - = l ---- 5t --------------------------------------------------- --------- -Phone---•-•-------------•--------------, <br /> Contrac t �' <br /> Installation will serve: Residence �Apartme�t House ❑ Commercial ❑ Trailer Court'[] Motel ❑ Other ❑ <br /> .5 X ' ----------------- <br /> Number of living units: ---j--- Number of bedrooms _-- Number of baths Lot size __--__�__ -_ <br /> Water Supply: Public system ❑ Community�syst m ❑ Priva+e Dep'h to Water Table ft. <br /> ��_ <br /> Clay E] Adobe [3 Hardpan ElCharacter of soil to a depth of 3 feet: Sand 'Gravel ElSandy.&M ❑ Clay Loam El i <br /> Previous Application Made: [If yes date---------- <br /> ---- ----) No ®/"New Construction: Yes g,-<o ❑ FHA/VA: Yes JR-"No ❑ <br /> - <br /> vTYPE OF INSTALLATION AND SPECIFICATIONS: r <br /> 1 cesspool ermined if ublic sewer is;aYailable within 200 feet.j r <br /> ,[No septic flank or c p p p 1f <br /> _ - r . � <br /> a ria4---C.� ei <br /> -ion -� __.__- .M <br /> nk: Distance from nearest welI -----Distance from foundat --. _ <br /> -- <br /> Liquid deptC __5e tic No. of compartments------ - - X �`�Q <br /> , <br /> Dis osal Field: Distance from nearest welli ...D'i'stance from found ation_._]--.___--Distance to nearest lot lina��_�-------. <br /> ' Nurnber of lines--------- -- ---Length of each line-___` `-- -- '� ---Width of trench.--_----rl ='-_r- ____-__-- -.Q- <br /> t s� <br /> "C Total length s <br /> Type of filter material--- of filter materia!_--.�__�._-�_____ g - <br /> Seepage Pit: Distance to nearest well___------------------Distance from foundation----------"�.__-.Distance to nearest lot line----------------- <br /> ❑ Number of pits--------------------- Lining material-----------------------Size: Diameter__'_? '; ---Depth-------------------------------- <br /> I �,I - , <br /> Cesspool: Distance from nearest-well--- _-__---.-_Oistance from foundation---------:----- -_.Lining material------------------------------- --- L <br /> Size: Diameter.-----•'------------------------------bepth------------------------------------------ Liquid Capacity- --------------------- g <br /> 0 Distance from nearest building ----------------------- <br /> Privy: Distance from nearest well--------------------------=------- ----------- I <br /> ❑ `_n; .--- '-s' "-------- ------------------------------------------------------ ------------ <br /> Distance to nearest lot line__----------- --- -- '- _�, <br /> TJt..3,..f ------------- ----------------------------------------------------- <br /> Remodeling and/or repairing (describe):__.---------------------- ----- ----- •------------ <br /> I -------... ------------------------------------------------------ <br /> - ----------------- <br /> 1 - <br /> ----- =---------------- ----- --------------------------- ---------------------------- --------------------------- --------- - - <br /> ------- -------- -- <br /> ! I--------- -------- --- ---------- --------- ---- <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 regulations of the San Joaquin Local Health District. <br /> t �_� -_ -- --- t <br /> _-,,(Sign } � r . , .-. - _ I Owner and/or <br /> --------- <br /> -------------------------------- - - - -------------------------- - --Title----- --------- <br /> (Plot plan, showing size of lot, locatiiih-of system in 'relation to wells, buildings, etc., can be placed on reverse side). <br /> l FOR DEPARTMENT USE ONLY <br /> ' ------------ DATE---- --��--'--��-�- -�e`---- --�--�---- ------- <br /> ---------------- <br /> APPLICATION ACCEPTED BY--__.--,.�___._ _'__� '. - ----- <br /> REVIEWED BY-----------------------------------------­ ------- - ----------•-------------------- --- ------------------------- ------ <br /> DATE_.-------------------------------------------------------- <br /> BUILDING-PERMIT ISSUED "`'`= ===_ _ ------------------3--.DATE---------------------------------- =-------===----------- <br /> -- <br /> .„ ,.,,,- ...�.,« .... .. — - ------ ------ •-------------- <br /> - ---------- --------------------------------------- --- <br /> Alterations and/or recommendations --------------------- <br /> --- <br /> ------------- ---=---- <br /> % <br /> _ .. - -- �-�-�---�`.���------------- ----- <br /> FINAL INSPECTION r- --- -- --------- <br /> Date---- -----' <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. <br /> 300 West Oak street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California <br /> Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 8-59 3M 3-'63 F.P.CO. , <br />