Laserfiche WebLink
—FOR OFFICE USE: <br /> ------------------------------------- --------------­;I APPLICATION FOR SANITATION PERMIT Permit No. <br /> ------------------------------------ ----------------- <br /> ------------------------------------- --------------- (Complete in Duplicate) Date issued —.................... <br /> This Permit Expi.res I Year From Date Issued <br /> -b <br /> Application is 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 w County Ordinance No. 549. <br /> .......vt <br /> JOB ADDRESS AND LOCATION.__ - -- ------ ----- <br /> ................ <br /> ---------- Pho ......I....... <br /> Owner's Name----- -- <br /> ............................................................................................ <br /> .... .... ........ . ..................... <br /> Address........................... ---------- <br /> 2 Phone.......................... ..... <br /> Contractor's Name_ - -- ---------------- <br /> rft <br /> jr Trailer Court 0 Motel ❑[3 Other 0 <br /> Installation v�iil serve: Residence C] Apartment House 0 Commercial 0 <br /> .11 Number of bedrooms Number of the -------- Lot size ......... .................. <br /> Number of living units. <br /> -------- 1� <br /> 1� 0' W <br /> Water Supply: Community system ❑ Private El Depth t Water Table 7 <br /> .y; Public system El <br /> ft- <br /> Character of soil to a depth.:iof 3 feet- Sand [I Gravel El Sandy Loam Z Clay Loam 0 Clay 0 Adobe❑ Hardpan C], <br /> - . 1 11, 1 ❑ FHA/VA-. Yes 0 N o <br /> Previous Application Madeili(if yes,date----------:�--------J'r No E] New Construction: Yes E] No <br /> TYPE OF INSTALLATION AND-SPECIFICATIONS-,. <br /> "A available_within 200 feet.) <br /> (No septic tank or c sspool permitted if pubric'sewer is av <br /> 1 <br /> ' . <br /> Septic <br /> nk: Distanc4 from nearest well__7a .'Distance from foundation------------------Material-----a ........ <br /> S_ Liquid depth <br /> No. of compartments---------- ---_---------SJZ,#i_ <br /> Disposal Field: Distance+om nearest:well------------------pistance from foundati8n. ............Distance to nearest lot line. <br /> .................... <br /> Number)'of"'Itn'es--------------------------------------Length of each line--- -.Width of trench__...Cl . 4, ofal length------------------------------------------ <br /> Typo of�ifilter material.-'--------------------------Depth of filter material-'-------_------------T <br /> Seepage Pit; Distance!to nearest well______________________ <br /> ell------------ --------- Distance from foundation....................Distance to nearest lot line_-------------_ <br /> .I ---------Depth-------------------------­ <br /> material---------------_-------Size: Diameter--------------- <br /> El Number,of-pigs----------------------Lining. <br /> !11: <br /> Cesspool: Distance from �nearest well---_------------Distance--from•foundation--------------------Lining material--------------------------------------- <br /> -------------Liquid Capacity-----------�­.............gals. <br /> ❑ Size: Diameter-----_1---------------------------Depth---------------------- ---------------- 91-a-ls <br /> weIIII t!___________________------- n -------------_------- <br /> Distance from nearest --------------------Distance4rom ne buildi g <br /> Privy- _j ------- -------------- <br /> n Distance to nearest lot line-------- --------------------------------------------------------- --- -------------------------------- <br /> Remodeling and/or repair 1�ng (describe):----------- <br /> ------------------- -------------------- - ------ ........ <br /> -----------I.I-----------------*-------- <br /> -------- <br /> ------------------------.......... / --------------/---------------------------------------------------- <br /> I __ - ---------------- <br /> L-------------------------------------------------------------------------------- 7:_=------------ -------------------------------------- <br /> ---------------------------------- <br /> 11 hereby certify that I.�have prepared this application and that the work will be done in accordance with San Joaquin County <br /> end regulations of Ithean Joaquin Local Health District. 1. <br /> ordinances, State law,",, nd rules a 7 <br /> ... ....______________(Owner and/or Contractor) <br /> (Signed)-------- --- - ---------- -------------- ...... -------------- ------------ ----------------------------------------- <br /> If ------------------ <br /> . . ... ... ...--------------------------_--(Tiltlo)----------2�------- ---------------..... <br /> ----- ...... T ­1- -- --- -------r <br /> can be.placed on reverse side). <br /> location system in relation to wells, buildings. <br /> (Plot plan, showing size of lot, <br /> FOR DEPARTMENT USE ONLY <br /> IDATE------ ------------------------- <br /> APPLICATION ACCEPTED BY---------- <br /> ,III ­­... DATE.........................•------------------------••-------- <br /> REVIEWEDBY------------------ - ----------------------------------------------- ------------------------------ ---------------­ DATE--------------------------------------------------------- <br /> BUILDINGPERMIT ISSUED------------------------------------------------------------------••----------------- <br /> ...................... ......------------------_--------------- <br /> Alterations and/or recommendations---------------------------------------------- ------------------------ ---------------------- <br /> ------------------------------------------------------ ---------_._---------------------------------------------------------------------------------------------------- <br /> -------------------------------- ------------ <br /> ....................... .....................ji---------------------------- ---------------- ---------------- ------------------------------------------------------------------------------------------------------------------ <br /> ffI----------------------------------------------------------------- ......................................... ............................... <br /> ..............----------------­--------:------------------------------------ <br /> 11. --- - ------- ------------------------------------------------------------------------------------------I---------------------------------- <br /> .............................._ ........I-------------------------­ <br /> I <br /> FINALINSPECTION -------------•------------------- Date---- --------------- ------------......................... ................ <br /> SAN.JO AQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street .12 4 iyeamore Street 205 West'01I46rnia 9th Street <br /> YVVv <br /> Stockton,California —- Lidl,Ccilifornia Manteca,California Tfacv,C <br /> ES 9 REVISED B.159 OM 5-61 ATLAS <br />