Laserfiche WebLink
APPLICATION FOR SANITATION PERMIT ermif 1 _.�f_..`�f <br /> (Complete in Duplicate) <br /> �d <br /> This Permit Expires 1 Year From Date Issue Da+ Issued ..-..--Application is is hereby made to the San!Joaquin Local Health District for a permit to con tru t and ' all the work herein described. <br /> This application is made in compliance'with County Or inance No. 549. <br /> JOB ADDRESS AND LOCATION � � � = <br /> Owner's Name ---------------------•-•----------•----------- -------------------------------------------- Phone-----•---------------------------7- <br /> Address --- ----••- <br /> Contractor's Name _ ----------,-•------------------ Phone <br /> �- - <br /> Installation will serve: Residence [�'-`Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of Jiving units:..-- -- f t size x---- 1 -------------------------- <br /> __- Number of bedrooms __ __ Number of baths � Lo <br /> N' !��.,,.r.r r <br /> Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table e-_ _ <br /> Character of soil to a depth of 3_feef: Sand F] Gravel ❑ Sandy Loam El Clay Loam'eClay ❑ Adobe.❑ Hardpan ❑ <br /> Previous Application Made: Yes ❑ No � New Construction:'Yes.5?,No ❑ FHA/VA: Yes Flo ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS:' ry <br /> (No septic tank or cesspool permiffed if public4e"wer is available within 200 feet.) C <br /> Septic T nk: Distance from nearest well"� _V—-Distance from foundation__.47--___.Material___ _ __ <br /> No. of compartments__ ---____.______.__Size _X4X__y'4F__Liquid depth___ ________________Capacity./"41--___-. <br /> I.. > J. r <br /> Disposal Field: Distance',from-. nearest well----..___--Distance from foundation...AP--- _!--Distance to nearest lot line-d-------------- <br /> 59 Number-`of Vines__: ------------------------Length of each of french--,?- --_----.------------------.-- <br /> Type of filter materiel-j�X* ___Depth of filter material----/__"--------Total length____1 ---'__________ <br /> Seepage 't: Distance to "nearest well ��: __Distanee from foundation__- �_�-{___.Distance to nearest lot iine__x `!_�..\ <br /> -.1 !A ` <br /> Number of pits----r--------------Lini g`'material__,XPi� ck__Size: Dia �•---------Depth_.A.-g-------------------- <br /> Cesspool; Distance from nearest well_________________Distance-from foundation_____._._-__ *_.Lining matetiaL. r___-.-__..__-_______._________ <br /> ❑ Size: Diameter Depth ` . = Liquid^Capacity-------------------------- gals. <br /> Privy: Distanceifrom nearest well---.------------------------------- .------------Distance fr�oriinearest building--------------------------------------- <br /> ❑ <br /> Distance to nearesr <br /> t lot Irne---------------------------------------------------------------�-------- --------- <br /> =`----------- --------------------------------- -------. <br /> ing and/or ing (describes:_..__- -____�- <br /> Remodel ---- --- <br /> `! t _ .. <br /> ------ <br /> ------------------------------------ <br /> f _ - - ------- -------------- -- ---------------------- <br /> --------- --- --- ----•---------•------------------------------- <br /> I - ------------------------------------- ------------------------------------------------------------------------- <br /> I hereby certify that I haveipreparg is application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regu"tions of the San Joaquin Local Health District. <br /> (Signed)------------ ---------- --------- -------------- { Contractor) <br /> i <br /> BY -------�------------------ ------ ---`-�---------------------(Title)---- � <br /> (Plot plan, showing size of lot, lgcation of system ' elation to wells, buildings, etc., can be placed on reverse side). <br /> y <br /> FOR DEPART NT USE ONLY <br /> W, <br /> APPLICATION ACCEPTED BY --F ,+: _.---------------- .._DATE � � �---���---------------- <br /> _., .M rr <br /> REVIEWED BY-------------------------------------- .............. <br /> ---------- -- -------------------------------------------------- DATE f <br /> BUILDINGPERMIT ISSUED----------------t-------------------=----------------------_---------•-------------------------•-- DATE------------------------------------------------------ I <br /> Alterationsand/or recommendations:'------------------------------------ --------------------------------------------------------------------------------------------------------------­--------- i <br /> „ . j. i ------------- ------ A <br /> --------------------------------------------- ------ ------------------------------------------------------------- ---------------- <br /> ----------------------- ----------•----------------•------------------------------------------------------- -----------------•------------------------------------------------------------------------------------------------ <br /> FINAL INSPECTION BY: _ --------------- ---------- Date <br /> /a-- fg'�c� <br /> SAN JOAQUIN LOCAL HEALTH rDISTRICT., � <br /> 130 South American Street 30D West Oak Street 132 Sycamore Sfreiet $14 North "C" Street 1 <br /> Stockton, California Lodi, California Manteca, California Tracy, California- <br /> a <br /> ES-9=2M Revised 8-'59 F,P.Co. _ <br /> A <br />