Laserfiche WebLink
rPermit No. <br /> APPLICATION FOR SANITATION PERMIT l1 <br /> (Complete in Duplicate) G// <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 /> PP � I <br /> This application is made in compliance'with County Ordinance No. 549. 1 <br /> + �. <br /> JOB ADDRESS AND LOCATI N_.�� ! +'4- :... ------------------------------------------------"-- <br /> - .Owner's Name--------- --•- ._,: .: _ -. Phon .� <br /> -......•.......- -- --------- ► <br /> 1 <br /> Address--•-- Phone <br /> Contractor's Name______.____._ <br /> c��r��------•-•---- -------•---•--...---�•- <br /> Installation will serve: Residence [��Apartment House [I Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: :�.. Number of bedrooms tR_ Number of baths _/... Lot size ---&I- --------------------------- <br /> Water Supply: Public system.❑ Community-system ElPrivate V�Deptlh fo'Water Table f+. 4, <br /> Character of soil to a depth"of 3"feet: Sand ❑ Gravel ❑ Sandy Loam El .Clay Loam E] Clay❑ Adobe�ardpan ❑ <br /> Previous Application Made: Yes ❑ INo [ '. New Construction: Yes El No ��FHA/VA: Yes E] No 17�r II <br /> s L <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: I f <br /> (No septic tank or'cesspool permitted if public ewer is available within 200 feet.) ` - : <br /> Septic Tank: Distance from nearest wel ..(�_._..__Distant fr m fo ndation-------------Matpn�l__�_5.r.. /-- -,-------------•--• <br /> P ' X Liquid depth._01 _..... CapacitY- w Q <br /> i� ' <br /> No. of comparfisne�ts.__.. . ` Size__ <br /> Disposal Field: Distance from nearest well..DI/;.....Distance from foundation.- ........Distance to nearest t li1�� --------.- <br /> Width of trench...G ' . <br /> �' ._.". Len th of each line.__ Q•-- <br /> La,S Number of lines---.., _----__ ------------�_I,� 9 --..._.._. � <br /> J+,�a Depth of filter material__..__1GP.�---.-.Total length....... <br /> of filter mate�iaL��. - ----- P � <br /> _ a—r'6f Z ��____-Dis� cue to nearest lot line....__._ <br /> Seepage Pit: D stance to nearest well__.. -----Distance fjo �fov ation___ a�77 <br /> , Size: Diameter.;; - h- ....... ._ <br /> - - .Linin materia __..._ Dept . ..- <br /> (�/ Number of . . ..". ....----•---- .9" _ - <br /> Cesspool: Distance f:om nearest well_____________ __ Distance from foundation---._.___.____......Lining material...-------._......._.__._..._......._. <br /> _Depth .. - Liquid Capacity._.._ 98's <br /> - <br /> %Diameter.. `"------------- <br /> Size: . . P `..-. "= 1 <br /> ' -. <br /> • � � Distance .from nearest building_________________._______._.• -•-••.----- <br /> Privy: Distance from nearest well -----------:--•---- "-- .-----., <br /> ❑ ., - <br /> Qistance.to nearest lot Ime--- :' -,J,�L�._.` <br /> Remodeling and/or repairing (descnbe):•--- �"� <br /> /J:s/r� <br /> ��� / <br /> t <br /> 7 ........................................................... ......� <br /> .. <br /> __ .......... <br /> __...__.I <br /> J ---------------------------------------------------------------------............................•---------- <br /> ".l -----•---•--•----�•------------•--------•-•----.._-----------•------ --- -- -------- <br /> ----­------------- <br /> - <br /> ::'" -- <br /> ..._.-----_•_... _ <br /> I hereby certify that l have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regu ations of the San Joaquin Local Health District. <br /> Contractor) <br /> {Si )_---------_----_-- --------- <br /> 9ned ._.._..----- <br /> (Plot plan, showing size of lot, location stem in relation to wells; buildings, of can be place on <br /> system <br /> reverse e. <br /> T�r FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY.................•. - ------- -- ---•--••••-------•---------•-•--. ------- DATE��.._---------------------------------" --- <br /> ' DATE- --�--�''-= - <br /> REVIEWED BY-----_------ -- <br /> - ------------ ---••-•-------•--•----------- <br /> BUILDING PERMIT ISSUED....:.... ......:......:..... ---- --•-------••-- .....-•--•••I__------- --...__..._... <br /> E_.....-- DAT - -..:. ...................... <br /> I ---•------•-•----------------- <br /> Alterations end/or recommendations:-•---•. ...-•---__.._..---- - -•- ------------•---....-•------ •---•---_. .._.____ ...._.---------. .......... <br /> f-7 . <br /> ` �-. ..- ` - _.... ._ . ` <br /> ------ <br /> ----------- --------- --------------------------------- <br /> I i ....-----.._.._-- _._........ <br /> _-_......------------------ ............. <br /> Date..---+ ... 1 '"� ................. <br /> FINAL INSPECTION" BY:.... i!& .....................•--_..__..-- <br /> SAN.JOAQUIN LOCAL HEALTH DISTRICT <br /> ' 132 Sycamore Street 014 North "C" Street <br /> 130 South American Street 300 West Oak Street � Y <br /> Stockton, California <br /> Lodi, California Manteca, California Tracy, California <br /> ES-9-2M Reviseo'l-57 F.P.CO. <br /> 11 <br />