Laserfiche WebLink
APPLICATION FOR SANITATION PERMIT Permit No. <br /> (COMPIOG in Duplicate) <br /> 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 appiicaf'10h,is made in compliance with County Ordinance No. 549 <br /> -------- --------1__'_1_-___ --------------------JOB ADDRESS AND LOCATION -------------------- X---S7 <br /> Owner's Name---------- --- ---- -------------------------I------------- Phone... <br /> -- <br /> -- <br /> Address <br /> ------------ --- -------------------------------------------- ------------------------------- <br /> ----------_----- <br /> Contractor's Name--- -----------T -------��� I Dt7r"F,"_0�0 ----------------- Phone----------------------------------- <br /> .. ................... .... --------------------------- <br /> Installation will serve- Residence a Apartment House [] Commercial [j.-Trailer Court E] Motel E] Other 0 <br /> lF Number of living units: J---- Number of bedrooms ---2-- Number of baths ___E-.-- Lot size _-__--.-61-C1- 13L----------------------------- <br /> Water Supply: Public system 0 Community system El Private K Depth to Water Table ft. <br /> El 5a­n4�17oa-m'D C&-am [] Clay [j Adobe Hardpan <br /> Character of soil to a depth of 3 feet: Sand El Gravel <br /> ❑ <br /> Previous Application Made: Yes E] No 1!9, New Construction: Yes [:] No K, FHA/VA: Yes 0 No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) f <br /> j <br /> nearest well---.a- --(---Distanc from foundation-----10-------Mafefi,,I <br /> Septic Tank: Distance from ne ----------Capacity----- <br /> No. of compartments_______ <br /> ----------Size----A&� -------Liquid depjh--- .... <br /> t ....fia(-------Distance to nearest lot line_______.-_ ! <br /> D;sposal Field: Distance from nearest well_____. -----Distance from foundation. <br /> Number of lines---------- ----Length of each line-------9, - ------Width of trench------- -------------------- <br /> M_ - ------------Total leng <br /> Type of filter I- -----JZ------X----Depth of filter material--- th---------1-40 ---------------------- <br /> Seepage Pit: Distance to nearest w-611----------------- ---Distance from foundation---- ---------------Distance to nearest lot line__._____________- <br /> ts --..:Size:" <br /> -- Size:-Diameter----_------------------Deptn----------- -- <br /> ----- --------------- <br /> 0 Number of' -----------------Lining material - -- <br /> Cesspool: Distance fro-m-nearest well-----------------Distance from foundation-------------------1ining material____._.__________________-_-___.___. <br /> ❑ Size: <br /> aterial-------------------------------------- <br /> 0Size: Diameter---------•----------------------'------Depth----------------------------- --------------------!-Liquid Capacity----------------------------gals. <br /> L <br /> Privy- Distance from nearest well___.-_____-_____________-----------------------Distance from nearest building-_______________________-_____..____.__ <br /> ❑ Distance to nearest lob line---------- <br /> --------- -------------- ---------------------------`-------------------------------------------------------------- <br /> � 1 ' r <br /> Remodeling <br /> ---------­_­---------------------------------------------------------------------- <br /> Remodelingand/or repairing (descr i--------------------i--------------------------------------------------------------------­-------------------------------------------------------------- <br /> --------------------------------------------------------------------- --------------------------------------------------------------------------------------f--------------------------------------------------------- <br /> ------------------------------------------------- ­----------------------------------------------------------------------------------------------------------- <br /> V 1 ) i t I <br /> ------------------------------------- ----------------­----------------------------- ---------------------------------------------------------------------------------------------------------------------------------------- <br /> I hereby <br /> certtfVthat I hav prepared f.his application and,that the-work will be,done in.accordance with San Joaquin County <br /> ordinances, State an ul s and regul ions of the San Joaquin Local Health District. <br /> - Owner and/or Contractor) <br /> (Signed)-- ------- --- ------- -- -- --- - ------ -----------------------------------------------I----------:--. <br /> BY:-----------!-----"----------------------------------- ------------ ---------------------------------------------------------------.-(Title)---------- --------------------------------------------- <br /> (Plot plan, showing size of lot, location of syste in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY---------------- ........- ------------------------------------------------------------ DATE---------- - ---------------------------- <br /> -------------------- ------ ---- ------------------------------------------ <br /> REVIEWED BY-----------P-----------I---------------- ------------------------------------- - <br /> - <br /> DATE <br /> BUILDINGPERMIT ISSUED----------------------- ----------------------- ---------------------------------------------------- DATE------ ------------------------------------------------------ <br /> ,eA -- - ---------------- <br /> Alteratio2t-- ------ ----------- -- ---- <br /> ,/n and or recommendations:------------------------------------- ----------- -------------------------- ---AV o <br /> .1,,_ 10�_ - I_ --------------- <br /> ----------- --------- -------- <br /> X-1-- _�4 ------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------ <br /> ------------------------------------------------- --------- ------------------I---------------- ------------------------------ --------- ---------------------I--------------------------- -----------------11---1------- <br /> ----------------------------------------------------------------------------------------------------­­------------- -------------------------------------------------------------------------- ------------------ <br /> FINALINSPECTION BY:------- 1�7-1- ------------------------;------------- Date----------- ----------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street , <br /> f32 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California C.J Manteca, California Tracy, California <br /> E5-9-2m . Revisocs 1-57 F,P.CO. <br />