Laserfiche WebLink
FOR OFFICE USE: ,, <br /> ------- <br /> 3___.____ rata_____-_._._. APPLICATIOR SANITATION PERMIT Permit No. ___,j 7�-3 -•_- <br /> (Comp e4riouplicate] <br /> �' ate Issued _..�- ... = <br /> This Permit Expires 1 Yeary Date Issued <br /> Application is hereby made to the San Joaquin Local Health District,for_b pfQnit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 50. `'""''.. ;r"'; <br /> JOB ADDRESS AND LOCATION______________ 7 <br /> _�___ P t <br /> Owner's Name--••---------_---------/?. S7' <br /> Address --------------- <br /> g.__.. -/ : -- ................................. <br /> -........ <br /> Contractor's Name._._..... ` X� •-' j�-_ .. l.. . ..:........... Phone...........-•--...-------•----•--- <br /> Installation will serve: Residence, Apartm n+ House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __1___ Number of bedrooms __-_ Number of baths ,/-- Lot size .___._ .................. <br /> Water Supply: Public system [�( Community system ❑ Private ❑ Depth To Water Table __ ft.- " <br /> Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loamn Clay ❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date--------------------) No,s]7 New Construction: Yes, ' ,No ❑ FHA/VA: Yes ❑ No ❑ <br /> 'TYPE OF INSTALLATION AND SPECIFICATIONS: n <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 /> ❑ i4,A47/ Y-No. of compartments--------------------------Size-----•-•------•-----------------Liquid depth------------- ,- ---------Capacity----------........................ <br /> Disposal Fiold: Distance from nearest well___1..,5�.5?�__bistance from foundation-__a ____.Distance to nearest lot line--- ..... <br /> Number of lines-----------,/___________________Length of each line---- .............Width of trench'_.-____ _._________________ <br /> Type of filter material._._,,&cA------Depth of filter material_____1�_-_-______Total length............2_37-------------------- <br /> Seepage Pit: Distance to nearest well—--OC— ____Distance from fou dation____-�_s _...Distance,to nearest lot line= ........ <br /> Number of its--.__ __.__. __Linin material___��..Size: Diameter-------�_ Depth____._.___�_ ----------------- <br /> Cesspool: <br /> _______________ <br /> Cesspool: Distance from nearest well_________________Distance from foundation-------------------.Lining material__--.--______-_____-___:_s________ <br /> ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity---------------=-------- gals. <br /> Privy: Distance from nearest well--------------_______--.--`______---_ ______Distance from nearest building----.---- _-__-___.._...________.._..___. . <br /> ❑ Distance to nearest lot line-------------------------------------------------------------------------------------------------, ° ------------------------------------ <br /> Remodelingand/or repairing (describe):-------- ----------------------------------------------•-•-•----•---•---••-•--------------- .................................................... � <br /> ------------•--••------------------•---•-•---------• •-----•----------------------------•-----•-----•--------•--••----------•--------------------------------------------------------...:...__....--•--- ------ <br /> ----------------------------------------------•-----------••---•--------------•---•--------------------------------- .........•--------..... -••-----•------------------------------------------------------------ --- <br /> ------------------------------•-------------------------------------------•-•--•---------•-•-•---•--•-----------------------------------------------------••--------------------------------------•----•--•---------------- <br /> 1 hereby certify that I have prepared this application and +hat 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) ---------- ---------------- ----------- -------------------------- Owner and/or Contractor <br /> By:----------------- (Ti+le)---------------------------------------- --- --- ---- --------- <br /> ---- - - -- ----- ----------- <br /> (Plot plan, showing size of!t, to ti of em in relation wells, buildings, etc., can be placed on reverse side]. <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY--- ----- ------------------------------------------------------ DATE------- 2 <br /> -- -- ... -•--------•---------- <br /> REVIEWEDBY------------------------------------------------------------------ ---------------------------------------------------------• DATE.........................................._------_------- <br /> BUILDING PERMIT ISSUED. - -----• DATE------------------------------ -----.--_----------•-------- <br /> Alteratio4 and/or recornme datio s:______._____._____________________ <br /> ----•--•-- ---- ............. ----------------.-----•-•-•--------------------------------------- <br /> --------- -3�1.To.`�1..._ 'Y! /t« --------------- <br /> FINALINSPECTION BY:..------ --------------------------------------------- Date---------------- - --•--------------------------------•------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Streit 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 8-59 2M 5-62 ATLAS <br />