Laserfiche WebLink
F?ROFFICE USE: <br /> ---------- <br /> --- - -------_---------- ------11 1... .....- --------------- ----- --------------­.- APPLICATION FOR SANITATION PERMIT Permit No. ....... <br /> --------------­--------------------------- (Complete in Duplicate) :-L_�—�, <br /> Date Issued //_ /�X I <br /> .............. <br /> ------------------ -------------------------- This Permit Expires 1 Year From Date Issued, <br /> Application is hereby made 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 /> JOB ADDRESS AND LOQATION. ........ f A <br /> -K.1........................----------------------------------------------- <br /> Owner's Name------------------- A. G: _C� <br /> --------------------------------------------------- <br /> Address-----------............------`2---G-~1-------- _(:2, L.M 19 <br /> ------- .................................................................................................. <br /> Contractor's Name. set.-_F----------------------61 <br /> ........... ------------------------------------------------------ Phone....................----•.......... <br /> Installation will serve: Residence g Apartment House E] Commercial [] Trailer Court [-] - Motel E] Other [] <br /> 4 <br /> .1. <br /> Number of living units. 49_ Number of bedrooms*..,2--- Nurriber of baths -------- Lot size ----_-------_----------------------------------------- <br /> Water Supply: Public systerril 9 Community system- r <br /> Orivate [] Depth to Water Table _...... ft. <br /> Character of sail to a depth of 3 feet: Sand [] Grav arn`�ancly' Lo � Clay Loam [:) Clay-E] Adobe El Hardpan F <br /> Previous Application. Made: (!f yes,date--------._.._-- - No ❑ New Construction: Yes E] No [3 FHA/VA. Yes E] No F1 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or ces. pool permitted,if public sower is available within 200 feet.) <br /> Septic Tank- Distance from nearest Distance from foundation.....lO--------- ............... <br /> No. of c66ipartments--------- ------Size--'- Liquid clepth..........V------______Ca pacity.......6A.0. <br /> Disposal Field: Distance from nearest Distance,f foundation-------/0 <br /> Tom ------------Distance to nearest lot line....... <br /> /I jr <br /> �e .__..___::Width of trench...........2------- -------- <br /> Number 'f lines-------------A�--- ------------L�ngth,of "each line-------V a <br /> 9m �5�r ---- <br /> Type of filter ma ' 66pth of filter material--------/_9-----------Total length................ <br /> material_ <br /> Seepaqe Pit: Distance to nearest/wil-----/00.7-T�-bis'tance f from foundation---//d----------Distance to nearest lot line__,Cx(2..... <br /> jk� - Diameter------- Depth-------- - 57 ........ <br /> Number 8f pits...... ---------Lining m�sterialc_ .-- Size. <br /> Cesspool: Distance from nearest well----------_----Distance from foundation....----------------Lining material..._______-.__:-_ .............. VV <br /> F­1 Size: Diameter--------------------------------------Dept h----------------------------------------------------Liquid Capacity----------------------------gals. <br /> .4 <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building___________._-_._._;:......_________.____. <br /> Distance <br /> uilding--- <br /> ----------------......--------------- <br /> Distance to nearest o ine---------------------------------- --------------------------_---------- <br /> Remodelingand/or repairing (describe):,------------------------------------------------------------------------------ -------------------------------------------------------- <br /> ---------------L---------------------------------------- --_--------I------------------------------------------------------------------ ------------------------------------------•------•-------... ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•--•--•------------------- ------ ------------------------------------------------------------------------------------------------------................................................................... <br /> I hereby certify that I ha ve prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State 1, ws, a, roles and regulations of the San Joaquin Local Health District. <br /> SI yx( .............. --------------------------------------------------------------------------------------I (Owner and/or Contractor) <br /> B : <br /> .................................. ................. ------------------------------------------------------------­­-------------.4rifle)-------------------------------------_------------------------- <br /> (Plot plan, showing size of lot,,'location of system in relation to wells, buildings, etc., can 66 placed on reverse side). <br /> FOR PEPARTMENT USE ONLY <br /> ------ -------- <br /> APPLICATION ACCEPTED BY-- --------------------------------------- DATE---------�/-/W_�I <br /> ------------------------ <br /> REVIEWEDBY------------------------I--------- ........ .. ------------------------------------------------------------------------- DATE------------------------------------ <br /> BUILDINGPERMIT ISSUED---!l=---------------------------------------------------------—-------------------------------------- DATE------_--------------.... <br /> Afteveions and/or recommendations:----------- ----- - --------------------- <br /> ,I. , --------------------- ----------------------------------------------------*-------------------------------------- <br /> --- -- - ------------------------------------- ------I --------- -- ------ -- --- ----------------------------_------------------------------------------------------------- <br /> - --- --- - --- ---------------- ------------------ --- ----- ... ------------- <br /> ---- ------- .... ------------ <br /> . . ....... <br /> -- ----- .7T!_.02:Q-a---------------m----------------------­ ------ <br /> - --- - - -------------- -- -- ----- ----- - -- <br /> FINAL INSPECTION BY:..A <br /> --------------­ ... ....... ----------------- Date-------- - ------------------.--------------------_-- <br /> -SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South Arnarkan Street j601wost Oak Street <br /> .1 124 Sycamore Street 205 West 91h Street <br /> Stockton,California Lodi,C-0 1 Manteca,California' Tracy,California <br /> CS 9 REVISED S-99 2M 5-451 ATLAB. <br />