Laserfiche WebLink
FOR OFFICE USE: I ej o <br /> c <br /> APPLICATION FOR SANITATION PERMIT Permit No. ............. <br /> ----------------------- <br />------------------ ------------------------------ (Complefe in Duplicate) Date Issued ---q_76 <br />-------------------------------------- ------r—---------- This'.Permit Expires I Year From Date- Issued <br /> Application is hereby made to the San Joaquin Local Health District for permit to construct and installthework herein described. <br /> This application is made in compliance with -County Ordinance No. 549. <br /> j Q f b­eAdrA 'amp <br /> JOB ADDRESS AND LOCATION_ ----------------------------------- <br /> 1" 5 - <br /> ----------- ....... <br /> Owner's Name------ ------- ----------------------------------- -- ------------------------------------- Phone------------------------------------ <br /> zf <br /> Acidr------- Zpw, ... --------------------.......................................... <br /> Contractor's Name—� --------------- •------ -------- PhorievllV...4IS-311- <br /> Installation will serve: Residence kg� Apartment Ho6se El Commercial El Trailer Court El- Motel 13 Other 0 <br /> Number of living units: 10- Number of bedrooms _2_ Number of baths Lot size --- ---------------- <br /> Water Supply: Public system C] Community. system ❑ Private Depth to Wafer Table OjOft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy LoamX Clay Loam 0 Clay ❑ Adobe E] Hardpan 0 <br /> Previous Application Made: (If yes,Bate.___.__.--,___.,_-.) No New Construction: Yes E) No FHANA: Yes [I No D <br /> TYPE'OF INSTALLATION AND SPECIFICATIONS: ' <br /> (No,sepfic tank or cesspool permitted if p4Ul5liC1;-_Sewer is available %0fhin-200 feet.) <br /> Septic Tank: Distance from nearest well___®_..._Distance from foundation--------------------Material--__C-_C._.1 <br /> -----------------Size- -Liquid depth_- c? - <br /> rest well .5- - --------Capacity--- 0 Is <br /> No. of comparfrinents-_Z, <br /> Disposal Field: Distance from nearest ---6-0. Diffirom foundation----I-Q!------Distance to nearest lot line..._.., <br /> Num: ber of lines---- -------------------------Length of:each line-----:_�0---P:-------Width of trench........Z-7 fir__-_--_-_--_ <br /> Type <br /> 1.10------------ <br /> Type of filter maferial_�_ ----- --- --Depth of filter material-----/oo'r------Total length---------------------V5---a--------- <br /> Se 0_�------ Distance from founclation-.�1_0K, <br /> ,We Pit: Distance to nearest-well-R_ -- 2,V4 Diameter--_E---.Distance to nearest lot line------5 <br /> Number of pits-----I --------------Lining material___ - --_---Size: bi --- Depth-------4--.---- -- <br /> -Cesspool: Distance from nearest well--_z—_ D i.sta nce from.-f6undation-------------t'_;-:Lining material-_._-___-_--__________._.----__-_-. <br /> Size, Diameter--------- I gal- <br /> -----------------------------Depth-----------------------------------------------kLiquid Capacity gals.' <br /> s. <br /> Privy..: Distance from nearest well---------------- -------------------_-.__._____Distance from nearest building__-__-_-__------__----_---__----_----_-._. <br /> ❑ Distance to nearest lot line---------- -------------------------------------------------------- <br /> --------------------------------------------------------- <br /> Remodeling and/or repairing (describe)-------- -4---------------------------------- --•--- ------------------I-----------7------------------------------------------------------------------ <br /> ---------------••-----------------------------------•--•---•- --------------------------------------------------------------------------------------------------------------------­----------------------- --------•-------. <br /> ------------------------------------------------------------------------------:--------------------------- ----------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------- ---------- --------------------------------------------------------------------------w----------------------------------------------------------------------- <br /> I hereby certify that I have prepWed this'' pplication 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 /> (Signed)----- <br /> -------- ...... __1-—--------- ----------------------- - ------------- -----(G4"W1991d*r Contractor) <br /> By:------------------------------------------------------------------------------------------- (Title)---------- ----------------- . ................. -------------- <br /> [Piot plan, showing size of lot, location of system in relation wells,. __6,ui1_dingA------------ <br /> A <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY_________ ------------------------------------------------------- DATE__ --------------- <br /> -------------------------------------------------------- <br /> REVIEWED BY----- ------------------------------- ----------------------------------------------- -----•-------• ----------------.-_.-- DATE <br /> BUILDING PERMIT ISSUED---------------­----' . i- ------------------------------------------------------------- DATE.------------------------------------------------ <br /> ------------------ <br /> Alterations and/or recommendations--------------------------------------------------:----------:-------M----------------------------------- ----------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------ --------------- ------------------------------__......I------ <br /> --------------------------------------------------------------------------------------------------------- ------ ----------------------------------------------------------------------- ------------------------ <br /> --------------------------------------------I------------- -----------------------------------------------------------------------------------------------------------------------------------------------I-_-------------- <br /> ------------------------------------------- ­-------------- -- ------ ------------------------------- ---------------------------------------------------------------------------------------------------- <br /> F1 NAL..INSPECTION BY.' -- -------- <br /> Date----------- <br /> - -- - -- -- -- ------ - <br /> Cf <br /> SAN JOAQ U I N LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> E9-9 REVISED 8-59 F.P.CD.ZM 5�60 <br />