Laserfiche WebLink
` FOR OFFICE USE: <br /> -- -- -'____ APPLICATION FOR-SANITATION PERMIT Permit No. __ <br /> __-___-__--------------- -- -------- <br /> :I <br /> - <br /> ------------------------------------------------ (Complete in Duplicate) <br /> -------- <br /> This Permit Expires 1 Year From Date Issued Date Issued <br /> Application is hereby made�':to the San Joaquin Local Health District for a permit to constrt and i �t� <br /> all et)ork herein described. <br /> This application is made in compliance with County Ordinance No. 549. - <br /> / 1 <br /> JOB ADDRESS AND• CATION `Z-4C � e- 7_ !=`'g- -- --------------------- -------- - ------ -----— <br /> Owner's Nam a >� _t� ---- Phone--------------------------------------------------------------------- ---- - � --------- <br /> ---------------------------- ---------------- <br /> -------?--- �t. .__ ---L. .� <br /> ------ •-------------- <br /> Contractor's Name----- ---------------------------------------------=----------------------------------------------•--- Phone................................... <br /> u <br /> Installation will serve: s Residen 4 Apartment House Commercial Trailer Court Motel Other <br /> ° li p ❑ ❑ f ❑ ,p ❑ ❑ <br /> Number of living units J_____ Number of bedrooms :;:3--- Number of baths __!_____ Lot size -__ <br /> Water Supply: Public system ❑ Community system ❑ Private [� Depth to Water Table/_()_ ft. <br /> Character of soil to a depf9 of 3 feet: Sand ❑ Gravel Sandy' Loam ❑ Clay Loam ❑ Clay ❑ Adobete <br /> Hardpan ❑ <br /> Previous Application Made:!l (if yes,date--- _______________} N� New Construction: Yes No ❑ FHA/VA: ❑ No <br /> TYPE-OF INSTALLATION rAND-SPECIFICATIONS: "Pi ...��. <br /> I ( p p p p available within 204 feet)Q 1 <br /> k <br /> Septic Tank: <br /> tic taDnk tancesfroml nearest well-- 76 sewer <br /> from found ti n______ ________.M�tsrial-.ir. 1�. _.___ ..--___-- <br /> -- y <br /> No. of compartments----Ir-----`-------Slze_ p./_ r[�- Iquld depth-- ----------- -------Capacity-.� f----�-- <br /> Disposal Field: Distance from neares well----7{1�.-._Distance from foundati rrr_ 4s+ance to nearest to iia_ �__,I C>3 <br /> Numbers of lines___.__ ____ Length of each"Iln T. _ �'�_ I �/idth of trench.A_ _� t --- <br /> ------->�------ J ----_-=-•-�-------- � rte, <br /> Type o-filter material____�``_�.__- Depth of filter material---�, __----------Total length-------____ ��ti7__________. o f <br /> Seepage Pit: DistanceII to nearest well---------------------- from foundation--------------------Distance to nearest lot line_.__________.___. <br /> ❑ Numbers of pits---- ----------------Lining material---------- ------------Size: Diameter-----------------------Depth--------------------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation-----:....... .... Lining material-____.._.-.-______________.________. <br /> ❑ Size: Diameter------------------------:-------------Depth------ --- -- ------------------------ -- Liquid Capacity--------------------- gals. <br /> = `-Privy: r�- Distance from nearest well_____ _____________ Distance from nearest buildin ___-_._.__-___________ <br /> - - ---- ------ ------------ <br /> Distance <br /> --- -- <br /> Distanceto nearest lot line--------------------------------------------------------------------------------------------------------------------------------------------- <br /> Remodeling and/or repairing (describe):__-�-� --- -------: ------------------------------------- <br /> ------------------------ li <br /> II <br /> ------" -----------------------------------------•----•----------------------------------------------------------------------------------------------------------------------------- <br /> I hereby certify that I.have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State la , and: ales and regulations of thezSa*--Joaquin Local Health District. <br /> (Signed) ` , �[r/ �1�c ?/1 p (Owner and/or Contractor) <br /> _ �� ----Title '�„-� _. � .� ;. <br /> i ----------------------------- ---•------•--•--- --•-------------------------- - -- ------------------------------ [ ---- - -- ------------ <br /> By: - <br /> (Plot plan, showing size of loft, location of system in relation to wells, buildings, etc., can be placed on reverse side). I <br /> �I FOR DEPARTMENT USE ONLY I# <br /> APPLICATION ACCEPTED BY-----------------------------­------------------------------------------ --------- DATE <br /> i REVIEWED BY--------------------- -------------------- ----------- ----------------------------- - DATE------ <br /> i�c <br /> BUILDING PERMIT ISSUE61 <br /> --------------------------- -- DATE _ - <br /> Alterationsand/or recommendations-------------------------------------------------------- ------------------------------------------------------------------------------------------------- <br /> 1I , <br /> l <br /> -------------_-----------------------_------------------- <br /> ____.--______.__.._______.______._.<--_.____________________________-_____._________.__.______....--___________._.._______------__-__.________.-._-.._._. <br /> ......---------------- ------------- - --- ----------------------__---_-____________.._.._---__-.-.-.-___.______________. __._______.__.__.-.__.__-__-_.------------------ <br /> ---------------------------------------- <br /> S , <br /> __________________________________----------------------------p..-._.________ <br /> ______________________----------__------_-------------------------_------------------------___-----------------------------------_____________________________ _ <br /> FINAL INSPECTION BY!--------- Date-------------------- 2 <br /> • = - <br /> �i SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E,Haxelton Ave.] 300 West Oak Street 124 Sycamore Street 205 west 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> II - <br /> £5 9 REVL5ED 6-59 3M 3-'63 P.P.CO. <br /> II <br /> � Il _ <br />