Laserfiche WebLink
i FOR OFFICE USE: <br /> i <br /> .. .. .. ................ APPLICATION FOR SANITATION PERMIT Permit No. -/?Z ...... <br /> ................................... ........... (Complete in Duplicate) r <br /> � <br /> Date Issued lD..•/�,.���` ; <br /> -_-..-_._..-.................................. This Permit Expires 1 Year From Date Issued 0-5-3_ ,b?O o7 i <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. + <br /> Phis application is made in compliance with County Ordinance No. 549. � ,�s.t <br /> JOB ADDRESS AND LOCATION....r r" G 'f`: " G_.- r'-��-rC '--- ................. !o .............. <br /> /YIf1 "d <br /> 6wner's Name--------------���___'_-'-�.f�.�...�'........ -'• <br /> • ------•�----• -- -- •- -�• --•----------•------'---------------- Phone,&_Z:5.�'-2.;�..----- <br /> Address-------------------•--- t -7 Q s"...... <br /> Contractor's Name._­ ��iole �..t`.11 .... :s! trc. .... -----_----- ----..... ...7...... <br /> , <br /> Ishstallation will serve: Residence El-"Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel F] Other ❑ <br /> Number of living unit-N-17 Number of bedrooms_K.__ Number of baths t-Lot size Wiz........................... <br /> Water Supply: Public system ❑ Community system ❑ Private 0-,pepth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam❑ Clay Loam Cg--Clay ❑ Adobe❑ Hardpan <br /> Previous Application Made: (If yes date..._. ) No Q---New Construction: Yes ❑ No O--FHA/VA: Yes ❑ No �.U' <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 /> No. of compartments.....__------------ Size.................... --------Liquid depth..................... •Capacity ---------- + <br /> � J, ' �c r <br /> Disposal, Field: Distance from nearest well..f�...,..�._-Distance from foundation.-/..............Distance to nearest lot line._____._____•._.. � <br /> [� Number of lines......_....__.. __Length of each line_____%%! -`______________Width of trench.___1'•, ,......._.____-__-___ <br /> Type of,filter materi !''al. ------Depth of filter material..fyr _' __._-_Total length_. .. __`......................... <br /> Seepage Pit: Distanc6 to nearest well l.,'IK..J......Distance fr m foundation-./�_'D-._..........Distance to nearest lot line._-�3v-.... <br /> Number'-of j......._..._Lining matenal_- _ _r��-Size: Diameter r.r...__Depth <br /> Cesspool: Distance from nearest well.................Distance from foundation....................Lining material.................................... <br /> Size: Diameter.-•----...._..._- De th...................................................Li Liquid Capacity ........._gals:, <br /> ❑ ....7-.Depth q P tY ................ <br /> Privy: Distance from nearest well.._.___.-__.-_.-----------........._._-__.Distance from nearest building__________________________________________ w. <br /> ❑ Distance to nearest lot line..................­ ............................. •---••-----.. --------------------------------------..._•-•--_.................... i <br /> Remodeling and/or repairing (describe):...__•_ � � ....._ ------ <br /> -----------------------'---•---•----..- --'- <br /> •-----------•- ---------------------­-------­-­--------. -. - ----------------------- <br /> ..................................•_ -- - <br /> -- ----------------••---------------------------------------•---------------------- <br /> i 1 hereby certify fha+ I have prepared +his applicafio and'thaf'-flie work'will-6{ d2fWin accordance with San Joaquin County <br /> ordinances, State lar,..a rules and regulations of the San Joaquin Local Health District. <br /> �i ned cam__ <br /> {. 9 )-.------- r��°.C'1__5 ---t---�- /' ._.... .........•-------..-----....._._.......-_..-----•-•---.....,R. wner and/or Contractor) <br /> By: :,-- ------• ------=------•-•---•----- -. — -• ............................... 1 <br /> (Pio+ plan, showing size of lot, location o system in-relation fd wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY__ ... . _ . . •-----'----•-•-•------------------------------ ............-••--•------- <br /> REVIEWEDBY.....--........................................................------------------------------------------------------------- DATE--------------___---------------------------------- i <br /> BUILDINGPERMIT ISSUED....................• - ----- -•------- ----------- ---'••------...-. DATE_-.-.-.-..._..---•---------------•--•------------------.--... <br /> Iterations and/or recommendations;.....................___---------------------..........................................................-.................................. <br /> 4------------------•-•--. --•----- ---•----•-----------•-----•-----------------------•...............................-----------•--------- <br /> I <br /> ........................................... .................................•--•••--...................._..•----•-...----......................................... .............................................. <br /> FINAL INSPECTION BY:... , .. - . ................... Date.... __ r.^4S"o*------............... ---- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 4th Street <br /> d� Stockton,California Lodi,California Manteca,California Tracy,California <br /> 7 <br /> F.P.1213. j( <br /> 7 <br />