Laserfiche WebLink
1 APPLICATION FOR SANITATION PERMIT Permit No. -r°..��.3_-... <br /> Com lete_in..Du locate / <br /> ....�.�:tloe ..� p p } Date Issued --------- -s.1{.r_-- <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 mddeTin�`cornpiiance'With Co`ur:ty Ordinance No:549. <br /> Y ; <br /> JOB ADDRESS AND LOCATION = g C` - <br /> ► r✓ _ 17 <br /> -------------------------------------- <br /> Owner's Name �1�¢r •--------.. ----------- <br /> Ad <br /> /�__'c� <br /> 7 <br /> Ad . a _�--- - -------=- - ---- - = <br /> ------------------------­ <br /> dress <br /> Con rector's Name-- ;:. ' t Phoney - �a <br /> Installation will serve. Residence Apartment House ❑ Commer ial ❑ Trailer Court ❑ Motel ❑ Other ❑ , <br /> Number of living units: --I--- Number of bedrooms _17- Numberrof baths ----/_ Lot size __/S12/Y--- -1----.---_F-_--__---- � <br /> Water Supply: Public system ;9 Commun1fy system ❑ Private® Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sandt lGravel ❑ Sandy Loam E] Clay Loam ❑ Clay E] AdC]obeX Hardpan <br /> Previous Application Made: Yes ❑ No ® ;WNeW onstruction: Yes ❑ No FHA/VA: Yes ❑ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS:,- ' <br /> I (No septic tank or'cesspool permitted ,if public sewer is available within 200 feet.) <br /> . . - ` MraISeptic T k: Distance from nearestwell------------_----Distance from foundation----------" "a_ atei ---------------o-------------------------------- <br /> N <br /> ------------------------ <br /> } <br /> _:-_. <br /> No. of compartmen s--------------------------Size----------------------------=---Liquid�depth._n ------------- crtY------------------ <br /> isposa eld: Distance from nearest well-----------------Distance from foundation----------- Distance to near.-elIQ line--_--_;--------.. <br /> Length of each line----------------------------.Wid�f`trenc --------------------------------- <br /> Type <br /> ---------- -------- ------ <br /> Number of lines-----------------------------------. <br /> F Type of filter material--------------------- Depth of filter material---_-__---to Total length' r-__ ------- <br /> e <br /> (I ` <br /> --------------- ------- W <br /> �F�d —_� --�• <br /> Seepage Pit: Distance to ea—well_.__. ._ Distance from # ndation---_/1�_.Distance to nearest lot line__ <br /> "'Size:,Diameter_-- De --------- <br /> Number of its------- ------------Lining material- <br /> cesspool Distance from nearest well-----------------Distance from foundation_-------------------Lining material-------------------.----------------- <br /> Size: <br /> --- s_._---.- <br /> Size: Diameter------- -------------------------------Depth`------M------------`-----------------------Liquid Capacity-----------------------------gals. <br /> C. <br /> Privy: Distance fro nearest weal_`. _-�-.�` �-------------Distance from;Barest building--=- __-_---.-_-_ ------.-. {� + <br /> ❑ Distance to earest lot line._- 7------------------------ I--------------------------\--- ------------------------------ - -------------------------------- l� <br /> Remodeling and/or repairing {descr bel --- ---- -- ---. . . t ^ <br /> _---------------- - ------------------------I_------- <br /> -------------------------I--------------------------- <br /> ------------------------------------V----------------- ---------- -------- --------------------I-------------- <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�laws, and rules and regulations of�i the San Joaquin Local Health Disfricf. i <br /> (Signed) d� ------- --------- ---- ""-`--- ------------------------ (Owner and/or Contractor) <br /> -------------------- --------------- 1------------(Title)-- qf- <br /> (Plot plan, s owing of lot, location of system in relation fo webs, buildings, lett., can be placed on reverse <br /> l; FOk DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY-------------------------------------------------------- ------------------------------------- DATE-------------- -------------- <br /> REVIEVVED BY;;.--==--------- --------------------------------------------- -- --- DATE ----- -------- <br /> BUILDING PERMIT ISSUED------------------------------------------- I QATE--- ------ # <br /> -------------- <br /> Alterations and/or recommendations:----------------------- - - I <br /> .r ----- ------- 10----------------------------' ---------------•------------------------------------•-------•------•----- '---- -_ -.. <br /> �7.� = 7 - -- - --- - - -- - - - --- - - - -- ---- ------- <br /> --a- --- ---- � I----- _�-_ _-:=a ____________________________________----_______-_:_-:_ :_:_--__:_--____--=--_._:::_:::--:---==---_::__------___---�------- <br /> ---------- #--------------------- ----- -- ---- ------- <br /> e <br /> - -- <br /> r <br /> FINAL INSPECTION BY:.__. -_ --- ------ .- ----------- - - -- Date_._--- --- "` -c - <br /> -- --- <br /> SAN JOAQUIN LOCAL EALTH DISTRIC <br /> 130 South American Street 300 West Oak Street __132 Sycamore Street 914 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy,-California <br />* ES-4-2M Revisea 1.57 F,RCO. <br />