Laserfiche WebLink
FOR OFFICE USE: <br /> -----------11------------------- --------------------- <br /> --------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. <br /> --------------------�, 7---------------------------------- (Complete in Duplicate) <br /> -----------------:--------------------------------------- This Permit Expires I Year From Date Issued Date Issued -zx4e- <br /> 0?,5-1 KO—El� <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein desCZj1:D d. <br /> T _a <br /> _ �i�. pplica,fipn,is <br /> -made in compliance with County Ordinance o. 549, <br /> Z <br /> --- ------- A <br /> -JOB-ADDRESS�, ATIO k-ea J, qiel_yz <br /> Owner's Na <br /> ...... . ..... -------------------------- - ------------- -------------- ------- Phone--- <br /> - <br /> Address--- ------- ------ —^ <br /> Contractor's Name - -------- <br /> serve: Residence Apartment <br /> ----------------------------------- <br /> ------..... --- <br /> 7&a r <br /> Installation will serfment House ❑ Commercial Trailer Court E] Motel E3 Other E] <br /> Number of living units: ----I Number of bedrooms A Number a" aths I--- Lot size ---4__a� ------------- <br /> Water Supply: Public system E] Community system El Pr Number <br /> to Wafer Table -------- ff. <br /> Character of soil to a depth of 3 feet: Sand [j Gravel [-] Sandy Loam Y Clay Loam [j Clay E] Adobe F] Hardpan F <br /> Previous Application Made: (if yes,date--------------- ---1 No E] New Construction: Yes E] No E] FHA/VA: Yes E] No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well_________________Distance from foundation--------------------Material------------------------------------------------- <br /> ElNo. of compartments--------------------t Size--------------------------------Liquid depth---------- ---------------Capacity----------------- ------- <br /> Disp,,/Fielcl: Distance from nearest well-__AR) Distance from foundafion,,___ieA---#.--.Distance to nearest lot line______.____. <br /> ..........Width of trench,_ �---------------------- <br /> Number of lines- Length of each line-00 ? , <br /> Type of filter material- of filter materi --- Total length___._ �40---------1------------------- <br /> Distance f m un <br /> a------' <br /> 14A!12V Distance to nearest wel' fo D ista lice to nearest lot line__. ' <br /> F] Number of pits-------/-------------Lining mate6a1_:,j.AR-------Size:.P;a.A�er____,2_Vwob epf h....../_415------------- <br /> Cesspool: Distance from nearest well/-----------Distance from foundation-------------------1ining material______..--__-------.___._ <br /> ----------- <br /> ❑ Size: <br /> aterial--------------------------------- <br /> Size. Diameter--------I -�-_ ----------_-__- -------- -------------Liquid Capacity----------------------------ga <br /> ------------- y <br /> Privy- Distance from nearest well--- --------------------------------DistInce from nearest building----------------------------------------- _�w <br /> ❑ Distance to nearest lot lir6t I ij - . <br /> -------------------------------------------------------------------------------------- --------------------------- ---------- <br /> Remodeling and/or repairing --------- - <br /> cr e-)-:, ------------ ------------------------------------------------------I-------------------------------I--------------------------- <br /> --------------------------------------•----------I-------- ------ ------ -- -------------------------------- ------------------ ----------------------------------------- <br /> ---------- <br /> -------------------- ------------------- ------------------ ----- ---------------------- ------------------------------------------------------------------------------ <br /> -------- ---------------:--------Z: ------------I----------------------- ____1---- --------1_2---------------------------------------------------------------------------------------------------------------------------- - <br /> I hereby cerfif I have prepared thiA <br /> s application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State aws, ,rulesre ations of the San Joaquin Local Health District. <br /> (Signed)--------------- ------------------------------ ------ - ------------ -- --------- --------------------------------------------------- d/or Contractor) <br /> By:--=------ -- ----- - ----------- ------ "-- - - ------------- ---- -------------(rifle)---------------------------------- -- - ------ - --- --- <br /> (Plot,plansho g-size of-lowells;bui inns, pIi_c_eon re <br /> d vers =d sidg) <br /> t <br /> FOR DEPARTMENT USE ONLY <br /> '4 <br /> APPLICATION ACCEPTED - ------- -------- --------------------f-------------------------- DA' TE---- ----r-- j-/------------------------------ <br />_—REVIEWED-BY-77----------------------------------- -- -------------------------------------------------------------- ---- -- DATE------------------------------------------------------------ <br /> BUILDINGPERMIT ISSUED---------------------------------------- ------------------------------:------------------- --------1 D AT E------------------------------------------------------------- <br /> Alterations and/or recommendations--------------------------------------------------------------------------------------------------------------------I------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> -------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------ ............ ----------------------------------------------------------------------------I------------------­--------------------- -------------- ------------------------- ----------- <br /> ----------- ------------------ -- -------------- -------------------- ------------------------------------------------------------------------I-------------------------------------------------------------------- <br /> FINAL INSPECTION BY: Date <br /> SANI------------------------- ------------------------------------------------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> $tocktan,California Lodi,California Manteca,California Tracy, California <br /> CS 9 REVISED 8-59 3M 3-'63 F.P.Cg;I. <br />