Laserfiche WebLink
F R OFFICE USE: <br /> - �" � -;{.............. . = APPLICATION FOR SANITATION PERMIT Permit No. .. .,��..7-,_�/ <br /> ................... -------- ---••--••------------- --- {Complete in Duplicate) <br /> •... •-•-••--•-• ........... This Permit Exires 1 Year From Date Issued Date Issued .•.. <br /> Application is hereby made to.the San IJoaquin 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. <br /> JOB ADDRESS A LOCATION ...G. ...5'Q oZ <br /> -----•----------------•---•------------•-- <br /> Owner's Name..... . ._. _ <br /> . -••-•-••........---•-•....... <br /> .-.... <br /> -..---- <br /> Address.,RVAO----••• ........ <br /> Contractor's Name............... . , <br /> ............................................ ........ <br /> Installation will serve: Residence Apartment House ❑ Commerciel Trailer'-Court <br /> 1 ._ ❑ ,� i ❑ Motel ❑ Otherr❑ <br /> Number of living units: _-..... Number of bedrooms o?.. Number of baths7/. Lot size .05�.J"C.-_ <br /> _..• .5------........................ <br /> Water Supply: Public system ❑ Community syste2� Private W Depth to Water Table 74_ ft. <br /> Character of sail to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay❑ Adobe 10 Hardpan ❑ <br /> Previous Application Made: (If yes,date .f................) No ❑ New Construction: Yes ❑ No W FHA/VA.- Yes p No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted-if public sewer is available within 200 feeq <br /> i .� <br /> e Tank: Distance from nearest well..•..............Distance from foundation.A....r..........Material.............................. l <br /> s No. of compartments... ----.-.Size--------------------------------Liquid 8epth..........................Capacity <br /> Disposa Field. Distance from nearest wel�/Odo-.___- Distance from foundation-_,ZQ _..:.Distance to nearest lot line...#_._.. <br /> �$ Number of lines.....__.__....._- Length of each line___a.4...................Width of trench..... <br /> T40 of filter material__ Depth of filter material____/.8-... <br /> YP ........Total length....................t.. r .'......... to <br /> Seepage Pit: Distance to nearest well 0-�.---_Distancef om fggundation...!�1Q,........Distance to nearest lot line......�� .._ r <br /> ,Number of pits.../.............Lining materia ._.. __C7.& .__.Size: Diameter._..,3„3_.��.--_•Depth_...,A., �__. <br /> --•-- <br /> Cesspool: Distance from nearest well,....'+_........Distance-from foundation--------------•.....Lining material•_.._...--....._....__.._...._ .:.-. <br /> ❑ Size: Diameter....... ...--.Depth--------------•--_------•--.-_... ................Liquid Capacity gals. <br /> erivy: ' Distance from nearest well----------------- _-- ..........................Distance from nearest building......................................... <br /> Cl Distanceito nearest lot line...................................... <br /> Remodeling and/or repairing (describe):-------- ........................ <br /> ................................'................................................................................... •-•---••------------- -•------•--........--•-........................................................ <br /> ....................-•---................---------------------- --- <br /> ..........--•--•.... ---- •-----.-t.­....,---------------------------------------------------------------•-•----•---•-----------------•--------•------.......------•-----•-----------..... .......................... <br /> I hereby 'fy that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinals, ate aws, pnd rules and regulations of the San Joaquin Local Health District. <br /> (Signed)_. caner and/or Contractor) <br /> -- -----Occation. <br /> ------------ ------ r <br /> ......-----•--•-------••-----._ .. - <br /> (Piot plan, showing size of tot, of syst�* e +ion to wells, buildings, etc., can be placed on reverse side). <br /> OR DEPARTMENT USE ONLY i <br /> APPLICATION ACCEPTED BY... �l�lip,1-------------•---• . <br /> REVIEWED BY................................ <br /> .......__ DATE ��' ��.�' l <br /> .............. <br /> .........................•-•- ------ ................................... DATE................................... <br /> BUILDING PERMIT ISSUED.................................... ............... DATE................. <br /> Alterations and/or recommendations:...S'..'?e.1.e_._�v_ .........l-___-_-_•_111:}. •l- <br /> Z .1..._. 4C..!- -� �..f_ �.....C�g�... ._._..._.. <br /> ---------------------•------•-------- <br /> I <br /> ....................................... •--•--••-•--•--..............._....-••••-----•---•--...................-•-•••..........................-....................• .•-• -..---•--•-•--......_........... <br /> .....................I ....................:................................................----........ <br /> FINAL INSPECTION BY:..-_ L - Data 41?.A <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1"I E.No:elten Ave. 300 west oak Sheet 124 Sycamore Street 205 West 91h Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED a-S9 3M 3-•63 F.P.Co. �fj <br />