Laserfiche WebLink
VVKUVH4t <br /> --- <br /> ---Y.S <br />------------ ------------- -------------------- APPLICATION FOP, SANITATION PERMIT Permit No. <br /> ----------- (Complete in Duplicate) <br /> This PermiVllixpires I Year From Date Issued Date <br /> issued <br /> --—----- -------------------- <br /> Applicafion 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 /> P <br /> 11 -, V . - ------- -- -----------_--- .................................. <br /> JOB ADDRESS AND LOCATION' IaRZY----- 'Ilbl <br /> Owner's <br /> Name....--.--. --------- --------•---------•---------- -------------------------------------- Phone----_------------------------- <br /> Address................------- ------' --- <br /> -- ........4..,. . ................._....... ------------- <br /> ................... ............ <br /> _. <br /> -- <br /> Contractor's Name = % . .... . .. ...... .... Phone ---------------- <br /> D------•-- <br /> Install Nion <br /> ---------_Installation will Serve- Residence (Apartment Hous6 E] Commercial E] Trailer Court [I Motel [] Other ❑ <br /> , _ <br /> of living units: .- Number of bedroo 's ._AP__ Number of baths _4, __t0..._..... ........................ <br /> .NumberF� Lot size ------r <br /> Water Supply: Public system ��Community systern-[-] Private Depth to Water Table 4�rft. <br /> Character of soil to a depth of 3 feet: ,Sand E] Gravel E] Sandy Loam E] Clay Loam [] Clay [] Adobe 2-lHardpan C] <br /> Previous Application Made: (If yes,clatej-14-�-._. -1 No [] New Construction: Yes E] No Rj-_'FHA/VA'. Yes [] No f <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> A IT6k: Distance from nearest well-------------------Distance from foundation--------------------Material-----------------2------- ...................... <br /> No. of compartments----------------------�`tSize--------------------------------Liquid clepth---------------------------Cap cityt-------------_------ <br /> i 51.rield: Distance from nearest well-----------------Distance from foundation....................Distance to nearest' lot line_...._...._...... <br /> "'e" <br /> Number of lines-----------------------------'----'Length of each line-------•---------------------.Width of trench-----..._...s...................... <br /> Type of filter material......------------------Depth of filter.m I-----------------------Total length----------------------------------------- <br /> Seepae it: Distance to nearest well 4'.Dista em fo ridation .-jo..........oisfancp to nearest lot ------ <br /> Number of pits------/--------------Lining mater I----em <br /> Diameter__-__ AT-----------_ <br /> Cesspool: Distance from nearest well-----------------Distaounclation--------------------Lining material__,--- ------------------------ <br /> Size: Diameter--------------------------------------Depth------------------------------------------ --------Liquid Capacity-.----------------------,...gals. <br /> Privy:I Distance from 'nearest well_______________________ '`.________----_---Distance from nearest building___._______..-_.___t......_........___.... <br /> ❑ Distance to nearest lot ------------------------------------- --------------------------i---- <br /> and/or repairing (describe):--------- ----------------------------- ------------------ <br /> --------------------•--•---------••--------------------------•........................... <br /> ---------------------------------------------------------A----------------------------------------------------------.............. ..................A---------------------- <br /> ------------------------------11------------------------- ..- I-------------------------------------I " x . . <br /> -------------------------------------------------------------------------------------- <br /> .....................­1................... ----------------------------------------------------------------- -------------------------------------------------------------------------------------------- ...... <br /> I erebype4ify that I have prepared this application and that the work will be done in accordance with <br /> th San Joaquin County <br /> ordinInces, ;afe laws, a d rules and regulations of the San Joaquin Local Health';District. <br /> _Ia , <br /> ontrac <br /> (Signed) ------ ....... ---------* ---------------------------------------------- -- -- ---- nor and/or C for <br /> ....I.......I <br /> By;_.................. ....... <br /> (Plot 11 - re W-—---_-----------------------(rifle)------ �_. , ........ ------- .................. <br /> plan. showing size of lot, location of system in !Oln to wells, buildings, efc., can be placed on reverse side). <br /> e <br /> OR D.EPARTMENJ USE ONLY <br /> APPLICATION ACCEPTED BY___ _ <br /> ----------------- DATE-_._#;V_. <br /> REVIEWEDBY----_-----•---------------- -------------------------------------------------------------------------------------- DATE------------------------------------------------------------ <br /> BUILD NG PERMIT ISSUED.-:/,I:------- -------------------------- <br /> -----;-------------------- -­--------------------- DATE.------------------------- )­................. <br /> 'iions and/or recommendations ----------------------- <br /> Altera ....... <br /> ................................................. ------- -------------------------------------------------- --------------------------------------------------------------------------­­­­.............. <br /> .......... -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------.........................................•---•--••-------- ------------------------------------------------- ------------------­----------I——........ ----------------------------------------------------------------- <br /> ---------------------- ------------------------------------------------------------------------------------------ --------------------------------------------------------------- <br /> FINAL <br /> INSPECTION BY;.,. Date--------------- --------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Svr*ot 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> tS 9 REVISED 8-59 2M 5-61 ATLAS <br />