Laserfiche WebLink
1 IR OFFICE USE: <br /> 1. <br /> __.•.••••,_•••---.--.-----•-------- APPLICATION FOR SANITATION PERMIT Permit No. <br /> ......... {Complete in Duplicate) Date Issued <br /> This Permit Expires 1 Year From Date Issued .D...- <br /> anon is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein desc <br /> ' )plication is made,in.comoiiarrcp with County Ordinance No. 549. <br /> .DDRESS A D LOCATIONdIdI't--- w ^l'1�!!!�. Q �d.-s "+�. <br /> 's Name_ ... ._ --r.•-•,� L.�If.�------... ..................................................._.___..... Phone----•---.:......_.... <br /> 11..Y3 a 7_f� _ ...r = _ - --------•- _ __ - — ------.__ <br /> ctor s Name_---- o�-3rr.R.drar�--- "-✓••-'6`e;`-�r'=r----------------------............................................ Phone.................. <br /> _ <br /> ' tion will serve: Residence [I Apartment House I] Commercial [:] Trailer Court ❑ Motel [j Other ❑IZ <br /> I <br /> Number of living units: _._.. Number of bedrooms ..-`�...', Number of baths ._t_ Lot size ..... _.___ ................ <br /> ' Supply: Public system ❑ Community system ❑ Private e Depth to Water Table ._-__ ft. <br /> for of soil to a depth of 3 feet: Sand❑ Gravel ❑ Sandy.Loam 21 Clay Loam ❑ Clay❑ Adobe❑ Hard[ <br /> Is Application Mede: (If yes,date...........:........I No ❑ —New CaonsttuOioq: Yes ❑ No ❑ FHA/NA: Yes ❑ I <br /> ' DF INSTALLATION AND SPECIFICATIONS: _._. <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.l""c' «des q � � � - <br /> }enk: Distance from nearest wolL.,.z �3 Dis#,a!]�� fro founde�tion..._, !?. :._...Ma+erial...5%f!.l4S�. .;__. <br /> ' No, of compartments...._,o2_._.__'4Sizi-%2_W..f ..Liquid depth._._-.`._.............Capacity... O e <br /> JsField: Distance from nearest well__-fik.�*.._Qistance from foundation...-L.Q........Distance to nearest lost lineSf <br /> Number of lines.......c�_____.. ...,._......Length of each line......�Q..__:.......Width of trench.__.-_;.....:._.. <br /> ' Type of filter material_�.TA....Depth of filter material....-/.:.._.......Total length...�b.o.-:............ <br /> le Pit: Distance to nearest well................._Distends from foundation.................Distance to nearest lot line....... <br /> Number of pits-------------------.Lining maferiat.___.............Size: Diameter... ...................Depth....................._. <br /> '01: Distance from nearest well..--------------Distance from foundation....................Lining material...............:_--_._..-_. <br /> Size: Diameter.....................................Depth--••--_.._...........--•-----------=---------.Liquid Capacity... ......._........._ <br /> Distance from nearest well._.._._.__._.._______-_.___..___--_._-.—Distance from nearest <br /> ' Distance to nearest lot line-....._............................................... ._ _—..----------_._._._......................... <br /> t <br /> sling and/or repairing )describe):_.................... ._..-----__.....__._.___..-._...-----._._..._..._.__..---•-_� _ <br /> _.--__------._..:.---_ _ —_.___-_—.____._._.__._.-_____..___-------_.__._----------------••----_......___.----•••-•-••--•-------------- <br /> .._..._......_............ _.....__...._.___.—_....__.._._..._..__...__...._—_.___...___...........—........................__.........._...._......— <br /> ._......_..__....._..._•__•.........--......_....................._...—_.-...._..........._--_-........_-_..............—----------------------- r <br /> 4oreby certify that I have prepared this application and that the work will be done in accordance with San Joaquin C <br /> ' ices, StaTes, and rules and regulations of the San Joaquin Local Health District. <br /> 1)----------- ----- - - -- - ----.------------ <br /> -•-•----•----•------:.----<-.._.........10nor and/orCon'xtt - :_._.__.:.._._ <br /> fi <br /> —� ... <br /> an, showing size of lot, location of system in vele n to wells, buildings, ate„ can be placed on reverse side).. I <br /> n FOR DEPARTMENT USE ONLY <br /> ' : _.!/ATION ACCEPTED BY... ............ ........... . .....------_--_----------------_------------- DATE._ .:n -. _. .__....:.._ <br /> VIED BY ------ <br /> -.----------•--............... <br /> ------......------.--------- 0---------- - - -._... DATE.---,� <br /> NGPERMIT ISSUED...-........._....._..._......._......__.__.......__....__._.........._........._... DATE----------................ . <br /> ionseAd/or reeommendeHom:..._..........._....................................._.___.............._--•--•-=-.--............_........_.._----------.... <br /> ........................................................................ _......._.___._..`_._..------i_'--"'-------_._._.._.._.__-- <br /> 1 <br /> ................. .............. <br /> 1 ........... <br /> _.... <br /> ...........----------------- <br /> _-.......—--------------- <br /> –---- <br /> _---- <br /> _-------- <br /> _._.............. <br /> ... <br /> _................. <br /> ..._....._......._....._.....------------- <br /> ------- <br /> _...__.. <br /> .............._............................._..................__....�..._.-....–....:--.__...-......................_..._....-.............-p........................_............._..._....-_.. <br /> L INSPECTION BY:._ t .. .. _. .... -............. Date__ '-/..y tt._...............--- .. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.1lamilen Ave. 300 West Oak Street 124 Symasore Street 205 West 9th S1rW <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> eEVISEa e-59 3M 3•'63 F.P.Ca. "' <br />