Laserfiche WebLink
APPLICATION FOR SANITATION PERMIT Permit No. _---_7.61-` q'­ <br /> (Complete in Duplicate) <br /> L Date Issued <br /> .pplica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> 4s application is made in-compliance. with County Ordinance No. 549. <br /> ueq 0 <br /> e <br /> 4a <br /> )B ADDRESS AND LO - --------------- <br /> s Name--•/ - -------4------R1---------------------------------- <br /> wner �, <br /> r t�_ —---------------------_----------------- - ------------- - -------------1:------------------------------ Phone-------------- -------------------- <br /> ddress---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ontractor's Name---I- ---------------------------------------------------------------------------------- --------- PhonA--- ------- <br /> -stallafion will serve: Residence 0--Xp­arfment House E3 Commercial [3 Trailer Court E] Motel El Other [] <br /> Number of living units: Number of bedrooms _.�_Number of baths j---- Lot size ---- ----------------------I <br /> Water Supply. Public system El 'Community system El Private94--gepth to Water Table AV_17ft. ' <br /> Character of sail to a depth of 3 feet:. Sand E] Gravel �ancly Loam 0 Clay Loam El Clay El Adobe 0 ' Hardpan 0 <br /> Previous Application Made: Yes E] No New Construction. Yes <br /> 'TYPE OF INSTALLATION AND�SPECIFICATIONS; <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septi Tank: Distance from nearest Distance from foundation-----/!�__'___.Material----- <br /> No. of compartments-------e-—------------Size---467-0-I-Q-0-----Liquid depth_l/ <br /> - ­......�Capacity. ------ <br /> Disposal Field: Distance from nearest well1106*----Distance from foundation__.sZ-O__:------Distance to nearest lot line---.)S...... <br /> Number of lines--------/------ -----------Length of each line-----------P0------------Width of trench:24"' <br /> Type of filter material--1-2-----------------Depth of filter material-----Zff..........Total lengthS?gq <br /> �p <br /> A SeJof--- --- <br /> Seepage Pit: Distance to nearest wel!----------------------Distance from foundation--------------------Distance to � s 11-,n------------------ -4) <br /> El Number of pits----------------------Lining material----------------------.Size: Diameter-------------------_._.Depth--------------------------------- 0 <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material---- -------------- _11� <br /> ------------<-----< <br /> F� Size: Diameter--------------------------------------Depth_---------------------------- ------- -------------Liquid Capacity_----------------- 111. <br /> r. <br /> Privy: _Distance from nearest well- ------ ---- --: ---- ---- ---- _Distance from nearest building_._______,------ ----------------------- <br /> ElDistance to nearest lot line--------------------------------------------- -------------------------------------------------------------------f--------------------- <br /> Remodeling and/or repairing (describe)------- ----------- ------------ ---------_------------------------------------------------------ ------------------------------------------ .... <br /> ................................------------------------7--------------- <br /> --------------------------------------------------------------------- ---------------------------------------------------------------------- <br /> I <br /> I.,"-. ", - <br /> --------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------ ----------------------------------------- <br /> -------------------------------- ------------------------------------------•----- ----------------------------- <br /> I <br /> -------------------I &ereBy—c-e-rTify--fga-+-"ame.:.propam <br /> ordinances, State laws, and;4es and regulations of the San Joaquin Local Health District. . <br /> jj <br /> (S:sgned)---- <br /> -.4Owner-and/or-Confraictor-) <br /> ---------- --------------------------- -----z-=iff----------------------- ---- <br /> By:..... ... ... ----—-------:--------------------------------------------------------------------(rifle)-------------------------------------------------------------- <br /> (Plot plan. showing size of lot, location of system in relation to wells, buildings, efc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY - ------ -- ...... ------ DATE-----____. __�_ . <br /> REVIEWED <br /> ATE-------- <br /> REVIEWED BY----- ---------------------------- <br /> ------------- 0----------------------------------------------------- ----------------- DATE <br /> BUILDING PERMIT ISSUED---------:----------- --------------- r------ DATF_ -.;--------------1,7-------- -------- <br /> Alterations and/or rep9mme clations: .71-'7---m-Q..__.._l�-------------- 4Z19P_Z1_;1r11�, <br /> n jj n-- ---1 ------------- -------------------------------------- <br /> f �,ee ----U--------- --- -------- <br /> :--I------------------- ----------------- ---------------=------------------------------------ ------ <br /> ---------------------------- - ------------------------------ <br /> --- ---- ------ - ------------------------------ <br /> ---A2_ <br /> --------------------- . ....... -------------------­------------------ <br /> -- ------------- ------------------------------------ <br /> ----­------­------------- -------- ---------�0_ --- <br /> row, (07- <br /> I AL INSPECTION Date--- ----------- - ------�CSZ------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore -Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, Califorh' Tracy, California <br /> ES­9-2M 145446 A7WOOD 12-54 <br />