Laserfiche WebLink
FOR OFFICE USE: <br />------------------------------------- ------------­- Permit No. .......L�� <br /> APPLICATION FOR SANITATION PERMIT ........... <br />-------------------------------------------------------- (Complete in Duplicate) <br /> ----------- ------------------------------------ This Permit Expires 1 Year From Date Issued <br /> date'Issued <br /> Application' i.s 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 LOCATION.................... ...............................................I................. <br /> Owner's Name------- ---------------------------------------------------------- Phone.,,A�........ <br /> Address............ -----------------------------------------------------------•-•---------------------------------------------------------------------..................................... <br /> Contractor's Name----------------L-L-o-._ 4. ..................- ......... <br /> ---------------------------------------------------------------------------- Phone........ <br /> - <br /> Installation will serve: Residence 10, Apartment House [3 Commercial E] Trailer Court [3 Motel E] Other El <br /> Number of living units: Number of bedrooms Number of baths ....1-_ Lot size ......... ......I--------- <br /> Water <br /> .....I--------- <br /> Water Supply: Public system Community system ❑ Private [] Depth to Water Table`..._:-_. ft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel'F] Sandy Loam-0. -.Cay Loam [I Clay C] AdobeK Hardpan [I <br /> Previous Application Made: (If yes,date--------------------) No' Now Construction: Yes E] No FHA/VA: Yes E] No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if publics sewer is available within 200 feet.) <br /> Septicj&nk: Distance from nearest well-----------------Distance rom foundation--------------------Material----------------........................... <br /> No. of compartments-------------------------Size--------------------------_...Liquid clepth............. ...---......Capacity------................. <br /> C1,17, <br /> Disposal Field: Distance from nearest well-----------------Distance from foundation___________________Distance to nearest lot line................. <br /> Number of lines----------------- ----Length of,each line------------------------------Width of trench.---------------------------------- <br /> k <br /> Type of filter m8terill-------------------- ____.Depth of filter material.--- .___;----------Total Total length....................--------------------- <br /> Seepage-4!ff-,A--id Distance to nearest well- Distance from founclation....../,O--------Distance to nearest lot ....... <br /> ❑ Number of pits--------/-------------Linin rnaLining I <br /> te'riaI-1)oG--4ek1_ize: Diameter___[r_k_.1__'___.Depth----- l_Z--—------------- <br /> Cesspool: Distance from neahest well-----------------Distance from foundation------------------- Lining material__.____.____._.___................... <br /> ❑ Size: Diameter-----F--------------- - --------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well-_________________..... . ---------- ------ <br /> .......... Distance from nearest building___-______________________-___.__-.___..-- <br /> -I- <br /> Distance to nearest lot <br /> ---------------------------------------------------------- -------------------------------------- ---__------ -------- <br /> Remodeling and/or repairing (describe ------ <br /> 0_0_(-e4 ------ ---- ---------- <br /> Z., . ..... <br /> ­------------ ---------------------- ---------------------------------------- <br /> ------------------------------------- ------------------------- ------------------------------- <br /> -------------- ------ ----------- ------­-- -_------------- --------.............. <br /> .................I-------------------------------------------------------------------- ....... --------------------------------------------------------------------------------------------------------------------- <br /> I hereby •certify fhatl have pre re I d this application and that the work will be done in accordance with San Joaquin County- <br /> 1 <br /> rule <br /> r <br /> In t 4 1 <br /> ordinances, State I d rulel red.ulati of. the San Joaquin Local H661th District. <br /> .. .................. ...... ....... -----------------------------------------1�------------......... -------?7------------------------------------(Owner and/or Contractor) <br /> [Signed}.__ .. ........... 4 <br /> ....... I - r --------------­--(Title)--------------------------------------------- ------------------ <br /> By:....................................... ----------L---- ---------------------------------------------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed an reverse side). <br /> R DEPARTMENTVS <br /> � E ONLY <br /> APPLICATION ACCEPTED BY---L --------- ............ DATE.--- :._. -------------------------- <br /> REVIEWED BY------------ <br /> -----------------------------------------------------------------------------_....... DATE-------•-----------•--------------------------------- <br /> --------------------------------------------------­ DATE---------------------- -------------------------------- <br /> BUILDING PERMIT ISSUED---, -- ------------- <br /> Alterations and/or recommencrafions;_ • <br /> ---/ 4-------------- -------- <br /> .......... <br /> -----------------------------------------------------------f----------q--------------------------1----------*--"----"--�---------------------------------------------.-------------Y----_--�--T-----1--------------------.-----------------------------------------------------------------------­---­----------------------.-?-.--. <br /> -.--.--.--.---4-.-.k-.-. <br /> -...--.- <br /> ..........I--------------------------------- <br /> --------­--­------- ----------- -----­:---------- -(C ------------------- ----------------------------- -------------------- .-.---.-.-.-.-..- <br /> FINAL INSPECTION BY --------------- ------------------------------------------------ Date.------------ <br /> -.--I-.-.--..--..--..--..-.-.-.--.-.-.-..--I.---.---.---.-- <br /> -.-­ <br /> .-.- <br /> Date-------------- ---------- ------------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Strad 300 West Oak Svioet 124 Sycamore Street 205 West 9th Strew <br /> Stockton,California Lodi,California Manteca,Califorcia Tracy,California <br /> ES 9 REVISED 8-59 OM 5-61 ATLA$ <br /> t <br />