Laserfiche WebLink
FOR, _FIC� US9: <br /> ------------ <br /> Permit No. <br /> APPLICATION FOR SANITATION PERMIT <br />----------------- -------------------- ------------------- (Complete in Duplicate) <br /> Date Issued <br /> This Permit rExpires 1 Year From Date Issued <br /> Application is hereby m.ade.to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549 <br /> -----401 <br /> WA ....... <br /> JOB ADDRESS AN LOCATION" <br /> Owner'! 7,04, ........... ---------------------------------•------------------------------------------------------------------ Phone------------------------------------- <br /> . 00 �1 . lac` : <br /> Address----------- - ----------- .... --------------------------------------------------------------------------------------------------------- <br /> WIA4;F_�i: - ------------- <br /> Contractor's Name---------------------- f`n./GHQ��1_ --­--------- Phone--------•--•--------_ ------------ <br /> �'D•---------------------- ----------------------------------------- <br /> Installation will serve: Residence g3`_Apartment House'E] Commercial [] Trailer Court [] Motel 0 Other [I <br /> Number of living units: Number of bedrooms Number of baths /0- Lot size 1,;�ZX ------------------------------- <br /> Wafer Supply: Public system [Community system te E] <br /> F Private Depth to Water Table 11-4 ft. <br /> I <br /> Character of soil to a depth of 3 feet: Sand E] Gravel L] Sandy Lba.m F] Clay Loam 0 Clay ❑ Adobe[Hardpan C1 <br /> Previous Application Made; jIf yes,date------------7--------) No gr New Construction Yes Ej--No ❑ FHA/VA: Yes E 'No E] <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___149______-__.Material_____ -------------------------- <br /> No. <br /> - <br /> - <br /> - ----------- -- <br /> -------- --- <br /> No. of compartments------;Z--------------Si Z e -----------L-lqqid dep.fh�_1:0.................Capacity_xe.V_A�------- <br /> Disposal Field: Distance from nearest el ------ from foundation--&...........Distance to nearest lot line-4----------- <br /> Number of lines_______.-- O� n., h line'_gav Widthoftrench.__a2_/------- --------------- <br /> ----Len Length of each - - ---------- <br /> Depth of-filter material__ <br /> ----- --- ----Total len'gt <br /> Type of filter materiah - <br /> Se isfanc� to near <br /> Pit: D est well----------------------Distance from foundation--------------------Distance to nearest lot line____________---_ <br /> Number of pits---------------•------Lining material.----------------.---:Size: Diamefer4L-------------------Dept h---------------------_-----_-- <br /> Cesspool: Distance from nearest well_________________Distance from foundation----------Z...... Lining material--------------1-1---------------------- <br /> El Size: Diameter------------------ -------------------Depth-------------------r-------------------1�-------------Liquid Capacity-----------•—-- ---------gals. <br /> Privy: Distance from nearest well--------------------------------------------------Distance from'nearest building------------------------------------------- <br /> t <br /> 0 'Distance to nearest lot line-.---.-_-____!:------------- ------------------------- -------- ------------------------------*----------------------------------- <br /> Remodeling an /or repairing (&scribe)-:! Ne --- -- ----- ----- ---------------------%,--- ---- -- <br /> , '�� --------------------------- ------------I----------- ------- <br /> 1117�` - <br /> ----------------1___ 7----------- <br /> --------- -- f <br /> �x�t f, ------­---------­----x------------------- <br /> 7'.6--1- ------------------ <br /> -----------------­ ----------- ---- --------------------- <br /> 0 "1 <br /> ------------------------------------ -----------------------­- ------------------------------—---------------------------------------------*----------------------------------------------------------- -------------------- <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 rule and regulations of the San Joaquin Local Health District. <br /> ------------------ 7 --- ------------:------- --------------------------------klwwm"W��r Contractor) <br /> (Signed)-------------------------- <br /> --- ------------------- ---------- ----------------- ---- - <br /> By:----------------------•----------------------------------- ------- <br /> (Plot plan, showing size of lot, location of s in relation to wells, buildings,.etc., can be placed onireverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY-_ -------------------------------------------------------------------- DATE......... ------------------------- <br /> REVIEWEDBY-------------------------------------------- --------------------=:--------------------------------------------------------- DATE----------------------------------------------------------- <br /> BUILDINGPERMIT ISSUED--------- -----------------------------------------------------------------•-------------------- DATE------- ------------------------------------------------- <br /> Alterations and/or recommendations---------- -------I-------------------------------------------------------- ----------•-----:---•------•-•----------------------------------.. <br /> --- -----------I----­ <br /> -- ---------- --------------------------- <br /> ------------------------------------------------------------------------------ -------------------I ­ <br /> ---------------------- ------------------------- ------------------------------------------------------------ <br /> ----------------------------------------------------------------------------------------------------------------------------------------- ------------------------------ ...... ------I------------------------------- <br /> s. <br /> --------------------------------------------------------I---------------------------------------- --------------------------------------------------------------------*------------------------------------------------------- <br /> --------------------------------------------------------------------- <br /> ----- ----------------- ------------ --- --------------- ----------------------- ---------- -------------- ---------------------------------- <br /> FINAL INSPECTION BY,.-.-Q.., -------------- --------------- ------- /Date---- ---------- --- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 730 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stacktonr California Lad],California Manteca,California Tracy,California <br /> E9-9 REVISED 9-59 F.P.130.2M 5-60 <br />