Laserfiche WebLink
FOR OFFICE USE: <br />--------------------------------------------------------- <br />--------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. . �...x.12_ <br />--------------------------------------------------------- (Complete in Duplicate) <br /> Date Issued .-.-__-_-_�/`-3 <br />---____-------_---____---- This Permit Expires Year From Date Issued -� _ 3a- 0-7 <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 with County Ordinance No. 549. r's`WL —a— 4 A <br /> JOB ADDRESS AN OCATION _ ,--- �- -- .-- _iK ._. - --------------- ---XC4,x---------------------- <br /> Owner's Nam L�/� _ Phone ---------------•-•-••------- <br /> r� <br /> Address -------•---------------•-------------- <br /> s F � t <br /> Contractor's Name_.. ---------- -------------- Phone...........................-------- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _1____ Numbar­of bedrooms __Number o maths __�___ Lot size ._._- - SLC __________________________________ <br /> Water Supply: Public system ❑ (Community system ❑ Private_?"Number <br /> to Water Table _------ ft. <br /> Character of soil to a depth of�3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay [] Adobe❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date--..--. --------f No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND.SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) i <br /> Septic Tank: a{ Distance from nearest well-----------------.Distance from foundation-------------------Materiai------------------------------------------------- i <br /> ❑ _ . , No.- of compartments- ------------------------Size--------------------------------Liquid depth--------------------------Capacity----------------------- <br /> Dispo Field: Distance from nearesf:7e_I•.44.. Distance from foundation-------1. ------.Distance to nearest lot line__-S-----_-_--- <br /> Number of lines--------J--_------------------Length of each line------ -----------Width of trench------`�_._------------------- +� <br /> Type of filter ,material- p it g W <br /> 14��yDe th of filter material______��'______.___Total length r_____________________ <br /> $eepa e Pit: Distance to nearest well____-d__ _.�:.__Distance from f undation____1�r'_�_.__..pist n`r to nearest lot line�,__r _.�___._ (� <br /> �, <br /> Number of pits-----.,,/_-----------Lining material_ 46__-_Size: Diameter--.---_-�_-__-_Depth__ __ _.___._.______ <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-_-____.-._-_-----.-----.-.--_-_-_--. <br /> IJSize: Diameter, -----------------------------.-- -De th----------------------------------------------------Liquid Capacity ---------- als. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-------.-----------_.__-_-----..-_-..__;; 1 <br /> ❑ Distance to nearest lot line---- ----------------------------------------------------------------- --------------------------------------------------------------------- <br /> Remodeling and/or repairing (describe):----- -. fx____ __ <br /> -------------------------------------••----------•-------------------------- ------------------------------------------------------------- ----------------------------------------------------- <br /> i <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. s, and rules an gulations of the Joaquin ocal He lth District. <br /> % <br /> (Signed) -- ------------ --------- ----------- ----------I------ ------ ---------- ntractorl <br /> By:------- - ----------- -- --- ---- --- --- ------ -- ------ -- ------ - ---- --------------------------------(Title).------------------ --------- -------------------------------- <br /> (Plot <br /> --------- ------ -----------_- <br /> (Plot plan, showing size of lot, location of system in relate In to wells, but s, etc., can be placed on reverse side). <br /> FOR <br /> DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ��xlih...: =_- ----------------------------------------------- DATE-1 <br /> - � ------------------------ <br /> REVIEWEDBY--------------------------------------- --------------- -- ---------------------------------------------------------------- <br /> ----DATE--------------------------------------------------•--------- 1 <br /> BUILDING PERMIT ISSUED--------- ------- -------------------------- ------------ --------------------------- ----------------- DATE--------- ---------------------------------- -- -------' <br /> ------ <br /> Alterationsand/or recommendations:------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> -------------------------------------•--------j----------------:------- - - -----------------------------------------------------------•--I------------------------- -------------------------------------------------•--- <br /> �' <br /> k <br /> s 7 <br /> FINAL INSPECTION BY:_ � �r�e�- --- ---:----- Date rr�.--+ ---------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hasellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 9-59 3M 3-'53 F.P.00. <br /> f <br />