Laserfiche WebLink
DPermit No. ��9,7 <br /> ,� of„- r} APPLICATION FOR SANITATION PERMIT <br /> �n� �� (Complete in Duplicate} Date Issued ---� .a <br /> 0 l C This Permit Expires 1 Year From Date Issued <br /> 3 <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 L TION--- _' --------------•---------------------------------- <br /> �y� �; Phone <br /> Owner's Name----------------- -- --- /f'F' <br /> Address------------------ %-- ---.------•-•---•-------------------------------------...---------. :---------------------------------- ----•---------------------------- <br /> Contractor's Name----- -� ------------------------------------- <br /> Installation <br /> ------ -'- Phone <br /> El <br /> Installation will serve: Residence R<Aparfment House ❑ Commercial ❑ Trailer Court' Motel ❑ Other <br /> Number of living units:.4--.. Number of bedrooms J.- Number of baths It— Lot size . 1--�-�a�_•2 <br /> Water Supply: Public systema El Community system rivate F-1 Depth to Water Table ��ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe g4--Hardpan ❑ <br /> Previous Application Made: Yes ❑ No g?" New Construction: Yes [T-`lo ❑ FHA/VA: Yes [ o ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS;_ '�tp <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.} s ,p <br /> Septic Tank: Distance from nearest well....'- -.Distance from foundation.... :_...Material..... _( <br /> ® No, of compartments---- -------------- Size., �� '1i���� Liquid dep li '.�...---------Capacity01111-' � <br /> -- --- -- - <br /> Disposal Field: Distance from nearest well---- ....._:Distance from foundation...-._.:g-_-_.....Distance to nearest of Il/e-- ------------- <br /> Number of lines----------`J"'-- ---'-„-„--�-ff--rtLength of each`line_.--- . �- +` Width of trench---- _ -------------- ----•-- <br /> Type of filter material. i?0_-Depth of filter material.__ `�:__.---Tota! length-------1w1_6?_____________________ <br /> �' s <br /> Seepage Pit: Distance �o nearest well....-_��....__-Distance from foundation.._„®._:.--.-_Distance to nearest lot line...*..._-_._ <br /> Number of pits.------d-`---_------Lining material--- (/ _.Size: Diameter---- . -------._.Depth---or��----------------•- <br /> Cesspool: Size: Diameter <br /> nearest well-_------___-_.._Distance from foundation----..--------------Lining material-__-........._-_...-__....._..._.... <br /> 1, �' --_Liquid Capacity ----------gals. <br /> meter--------------------------------------Depth_ - -- ---- q P Y <br /> --� <br /> Privy: Distance'from nearest well--------------------------------- <br /> ----------------Distance from nearest building--------------------------------------- _ <br /> ❑ Distance to nearest lot line ---------•-------------------------------------------- <br /> Remodeling and/or repairing (describe)=-----------/ ` <br /> .............................................. ii--------.... ...'........___• .._................-_.___•......_..___-- .....____.....-..-._..----------------------------------- <br /> ----_ ----....---......._--...--------.---------------------------- <br /> -------------------- <br /> lication and that the work will be done in accordance with San Joaquin County <br /> I hereby certify that I Have prepared this app <br /> ordinances, State laws, and res and regulations of a San Joa uin Local Health District, t <br /> Si ned _ -------------------------- r Contractor) <br /> -- --------- -- <br /> - (Titlep --------------- -------- <br /> By--------------------­-------------------------------------- ---- -- --------- ���� <br /> --- - - -- --- --- - - <br /> (Plot plan, showing size of lot, location of s ste in.relation to wells, buildings, etc., can be laced on reverse side). <br /> j FOR DEPARTMENT USE ONLY <br /> ACCEPTED;�BY-------------------------------------- ---•--------- ------------------ DATE--------- -------------------------- <br /> APPLICATION <br /> REVIEWED BY---------------------- DATE <br /> BUILDING PERMIT ISSUED” - --------- ------------- ------------ ---- --------------- <br /> Alterationsand/ reco endations: -------------- -------------•-----------•--------•---------------- -------•--------------------------------------------------------------------------- <br /> ------------------------------------------------------------ <br /> ---•-----------------------•----------------------•-------------------------------- <br /> ------------------------------ <br /> ;I ---------- -------------------------------- <br /> li. ------------------------------------------- <br /> FINAL INSPECTION BY:'l---------------!✓__,_---.------------------------ ----------- Date---- `a ---- <br /> 1 SAN JOAQUIrN LOCAL HEALTH DISTRICT <br /> 130 South American S+rest• 300 West Oak Street 132 Syciniore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy. California <br /> u <br /> FS9_2MRevised 8 '59 F.P.Co'. <br />