Laserfiche WebLink
1�,� j � <br /> IOD <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) N Da-te Issued <br /> gplicA <br /> a4ion is hereby made to the San Joaquin Local Health District for a permit to construct and install 66 work herein described. <br /> This <br /> application is made in compliance with County Ordinance No 549 <br /> ------------ <br /> ---- - ------ --------- <br /> JOB ADDRESS At*DLOCATIOM_�2�2_9_7 - - ----- ---- <br /> 4------------------------- ----------Owner's Name­/"J-�/� ----------------- <br /> L;?. Z/1 /Y I_:-------------------------- Phone----------------------------------- <br /> ----------------- ------------- ----------------- <br /> ---------------------------------------­------------------------------------------------------------- <br /> Address & <br /> ------------------------------------------------------------------ Phone. <br /> Contractor's Name.------------------------► ---------------------------------------------- <br /> Installation will serve: lRe5idenceP64 Apartment House E] Commercial L] Trailer Court E] Motel Ej Other E] <br /> Number of living units: --------- Number of bedrooms A_ Number of baths ___1-_. Lot size --------- -- -- -____________-__--_--__ <br /> Water Supply: 'Public,,.system " Community syst6m El Private E] Depth to Wafer Table -------- ft.' <br /> Character of soil to a depth of3 feet: Sand L] Gravel Ej Sandy Loam E]- Clay Loam Ej Clay E] Adobe Hardpan ❑ <br /> Previous Application Made:.-Yes Ej No #0 New Construction: Yes Not] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic fanVor cesspool permitted 1f public sewer-is-available within 200 feet.)- A <br /> AWclation--- dial_-__Tank-" Distance from neares� well----Y_A__'C,_�Dis+ance from foundation__.,_ M - <br /> -Size <br /> 1_x:_kx__(r Liquid depth---- ._Capacity----6.0-0-------- <br /> No-'. of compartmen.ts---------- I--------- <br /> Di I Field: Dis'tan'ce from nearest well.Nf 6.k-T,.pistance from foundation _?___d __-Distance/T_Distance to nearest lot line----------------- <br /> '4 — Length of each line____ ---�_l Ili <br /> Number of lines-----4---V_-A-------- A -------------- tj <br /> Nu /_-� Width of trench <br /> Ty' IR ty <br /> Type of filter maferial_64.�i Pepth of filter material__ -----!---------Total ;length--- 1_2,0------------------------ <br /> Seepa�ge Pit Distance to nearest well_.________________--- "_'Disfance7fro�n foundation_.._________ Distance to nearest lot line-1*1 L_41 <br /> 0 Number of pits----------------------Lining material-.---------------------Size: Diamete'r-------------------------Depth--------------------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------I---- Lining rinaf6rial--- ----:-----------I---------------- <br /> 1771 Size: Diameter------------- --------------- --------Depth-------- ----•----------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well---------------- -------------------________-_Distance from nearest building_ <br /> ❑ -Distance to nearest lot line------ '---`- ---------------------------------------- ---------------------------------------------------------------------------------- <br /> Remodeling and/or repairing Idescribe)------- ---------------------------------------------r=------------•---•----- 4i <br /> ----------I­-------------------------- ------------- <br /> ----------------------------------------------I------------------------------------------------------------------:------------ ----------------------I-------------------------------------------------------------------- <br /> -------------------------------------------I-----------------------7--------------------------------------------------------------------------------------------------------------------------- ------------------------------ <br /> ---------------------------------------------------------------------------------------------------------------------------------------- ---­:-------------------------------------------------------------------------- <br /> I hereby certify that I have-pre-par ed 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 /> A <br /> Z- -"`"` ---------------------{Owner and/or Contractor) <br /> (signed)...Y, - ------------------------ - ----- ------------ <br /> By: Y- 4rm. ------------------------------------------------(Title)---------------------------- ---- ----- <br /> ------------------------ --- <br /> yaz�------------------ - <br /> o'cation-of.system in-relation4o 'wells, buildings,,bfc.�can"beilplaced-on-r.e.vo�rS e side). t <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY.-------------------- ------------------------------ ----------------=----------------------- DATE-----------lzz�-----------I--------------------------------- <br /> REVIEWEDBY---------------------------------------------- ----- -- ----------------------------------------------------------------- ----- DATE----------= -------------------------------------- <br /> ------------- <br /> BUILDING PERMIT ISSUED----------------------------- ---------- --------------n--•---------------------------------------- DATE---------------- --------1­-------------­------ <br /> Alterationsand/or-recommendations:------- ----------- - - -------------------------- ----------------------------------------------------------- -------------- --------------- <br /> ------------------------------------------------------------- ------------------------------ ----------------------------------------------------------------------- ------- -------- ___ ».......»-- ____ <br /> ----------------------------------------------------------I----- ----------------------- --------------------------- --------------------------:------------------------------------------ <br /> k ------ ------- - ---------- <br /> -----•--------------------------------------- _----------------------------------------------------------------------------------------------------------- --------- ------------L---------------- ---------------------- <br /> --------------------=-`------------------------------------ -`------ -------------------------------------------------------------------------------- --------------- _ -------------- <br /> FINAL INSPECTION ----`=----------- Date-- <br /> -/ ---g-------------------------------------------------------- <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, California Tracy, California <br /> E5--9-2M Revised W-2100 <br />