Laserfiche WebLink
FOR OFFICY USE: <br /> ------------- <br /> I.............��_;�k----------- APPLICATION FOR SANITATION PERMITY PermlNo. <br /> ----------------------- --------- --------------- (Complete'in Duplicate) <br /> --------------- --------------------- ---------------1 This Permit Expires-1 Year From Date Issued DIN Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and 11 Me-re-in described. <br /> This lication is madin compliande with Co �M <br /> Count No. 549. <br /> I$ 4 r <br /> D <br /> OCATO <br /> ---- -- ------------- <br /> JOB CDRESS A21NLOCATIO 4-1n.-A/-- --------44-------4----- ---------------------_ <br /> Owner's Name--- <br /> -------------------­---------- ------------ ---------- <br /> A -k--- Phone-... <br /> Address--------AM........... ............ 190 <br /> ­----------------------­-- -------9_4 ----------------------------------------------------------- <br /> Contractor's Name------------------------------ <br /> ..... - - --------- El---------------------- ---- ---------------------------------------------------------- Phone------......•---•---------------- <br /> Installation will serve: Residence 2'�'Apartment'House Comrnerc" ial­6 Trailer Court El Motel C] Other El <br /> Number of living units. _4- Number of bedrooms _J_ Number of baths ?--- Lot size --6O _Kl <br /> Water Supply: Public system E] Community system 2--p-16vate E] Depth TO Water Table ---4.6 ft. <br /> Character of soil to a depth of 3 feet': Sand E] Gravel [3 Sandy Loom E] Clay Loam E] Clay E] Adobe 91"H"ardpan E <br /> Previous Application Made: ilf yes,date-----------------__) No FNew Construction: Yes �o E] FHA/VA- Yes 2T-'__N0 El <br /> TYPE OF INSTALLATION AND bft[_;lHL;AlIONS: <br /> (No septic tank or cesspool p4rmifted if public sewer is available within 200 feet.) <br /> Septic �Tek: Distance from nearest well,_- -----Distance from founclation,/6..............Material_ja?�s?'_ <br /> -----------L <br /> No. of compartments----------9---------.-_Size_1��_X_67_-__Liquid clepth___.<,........ .........Capacity.- <br /> l( <br /> Disposal Field: Distance from nearest well..___-" --------Distance from foundation.---------------Distance to nearest lot linecs—fj <br /> Number of lines.1,---------4��----------------Len'gth of each line...X5:7___4-----------Width of trench.-.Z-3- ...-------------_.--- <br /> Type <br /> ------------------- <br /> Type of filter materia r7-0_(/C----------Depth of filter material.../-F----------------Total length--------/�Sv <br /> I --------------------------------- <br /> Seepage,Pit: Distance to nearest well-----— ------.Distance from foundafion-/O..............Distance to nearest lot line---L5.............. <br /> I�r Number of pits___'-2--------------Lining material.34 C_�---------Size: Diarneter__:�-�.. ........Depth----.14re­••--_---_-_ <br /> Cesspool: <br /> ---------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------_---------------- <br /> ❑ Size: Diameter-----[--------------------------------Depf h---------------------------------------------------- qpy- -----------------Liuid Caacit - <br /> I. --------gals. <br /> Privy: Distance from nearest well------__-__----------------------------- -----_Distance from nearest building--------------------------_ <br /> 0 Distance to nearest lot line-------------- <br /> Remodeling and/or repairing (describe);------------------------ -------------------------=-•------ ---------------------------- ----------------------------- <br /> ------------------------------------------------- -------------------------I--------------------------------------1-------------------------------------- ------------------------------------------------- <br /> -------------------------------------------------------I --------%---------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------- -------------------- -----------------------------------------------------------------------------­­­--------------------------­--••----•--------------------------- <br /> I hereby certify that I hay application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and r es a red <br /> ions of the San Joaquin Local Health District. <br /> CZ <br /> (Signed)---------------------------------- <br /> ...... --------------- ----------------------------------------- ------------------------------------------(Owner and/or Contractor) Mry <br /> By%1�--- ------------- .. ------------------------------------ --------------------------------------------.(Tilf 10)------------------- -------------------- ----------- <br /> (Plot plan, s i In e of loca io of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> 'y certify <br /> y that I_`hay <br /> State laws and r a regu, i, <br /> 0 of syst, <br /> ... ........ ......... <br /> ... ............... <br /> in . e of loc, <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY. <br /> j------- ------------ ------------ DATE------ 7---- <br /> & <br /> -------- <br /> REVIEWEDBY------------------------------------ -----V------------ -------------- _------------------------------------------------ DATE---------------------------------- <br /> BUILDING ------ <br /> PERMIT ISSUED----------_----- --- ---- DATE--------- <br /> Alterations and/or recommendation! <br /> ------------------------------------------ ----------------------I-------------------------------------------------------------------------------------------------------------------------- ----------------------------------- <br /> ------------------------------­­------------------------_----I-------------------- ------------------------------ -----------------------.....................................-----------------------------------•----......--. 1 11 1 <br /> ----------------------- ­---------------------------- -----'----- --------------------------------------I-- --------------I---------------- <br /> ----------------- <br /> ........................................................ ...................... --------------------------------------------------------------------------- ---------------------------------------- <br /> FINAL INSPECTION BY ----- <br /> ------------------------------ <br /> D <br /> 0 U <br /> SA;Z INeO'CAL HEALTH DISTRICT <br /> 730 South American Street 300 Woof Oak Street 724 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Ttacy,California <br /> ES 9 REVISED 8-59 2M 5-6Z ATLAS <br />