Laserfiche WebLink
FOR OFFICE USE: <br /> ------------------------------- ----------- ----------- - <br /> APPLICATION FOR SANITATION PERMIT Permit No. ./ �.-...q <br /> ------------------ ------ ------------------------------ (Complete in Duplicate) <br /> This Permit Expires 1 Year From Date Issued Date Issued 4_4/_!k_54 <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. ' <br /> JOB ADDRESS AP9 LOCATIO --------------------------- --------------------------------------------- <br /> Owner's Na n - ----------------- ------------------- ------------------------------- -------- ------------- Phone------------------------------------ <br /> ---------­ <br /> Address <br /> ---•------------------------------- <br /> F6 ' _____________________________________________________________________ -. <br /> ___________ <br /> Address__ ----- --- ---- --- �� <br /> - <br /> Contractor's Name--------------------- ---- -- R -------------------------•--- Phone------------•-••------------------ <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ----L Number of bedrooms _--I._ Number f baths --.J--<-'Lot size __._- r...r� --------•-------------- <br /> Water Supply: Public system E] Community system El Private [Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel E-] SandyLoam E] Clay Loam ❑ Clay dobe ❑ Hardpan ❑ <br /> Previous Application Made: {If yes,date--------------------1 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.) <br /> Septi ank: Distance from nearest well------4 !......Distaue f from foundation-_/V -___-_ __ __-______--� <br /> No. of compartments_____..Z-------------Size/_____ _.__._.Liquid depth_-__.-.............._F-Capacity_/��a <br /> ' y - <br /> Dispos ield: Distance from nearest well__.., Distance from foundation--- __.-__.__.Distance to nearest lot line-a$--_-----._.. <br /> Number of lines--------- -----------------------Length of each line------.1iOC-1_..............Width of trench-_-_�"-_',---____-------------- <br /> Type of filter material____.ed_4-----Depth of filter material-------IX_0......Total length.....-_... _, _4y-_----------------- <br /> [ .See to well----- --- Distance b <br /> Number of pits.---- -.- -_ Lining material-- __.___Size: Diameter_______a:�_"Depth____2S'----- -----------_ 7 <br /> Cesspool Distance from nearest well.................Distance from foundation--------------------Lining material------------------------------------- <br /> El <br /> ___________---------------- -----❑ Size: Diameter------------------ -•---------------Depth--------------------- ---------------------------.-Liquid Capacity- --------------------------gals. <br /> Privy: Distance from nearest well--- -------------------------------------------_Distance from nearest building.--.----------------------------------- P <br /> ❑ Distance to nearest lot line-- --------------------------------------------------------- ----------------------------- <br /> Remodeling and/or repairing (describe):-------------- -- ---------------------------------------------- ------------_-__-------------------------------------------------------------------- <br /> ------------------------------I----------------------------------------------------------------------------- <br /> ---------------------------------------------------------------------------------------------------------------•--------------------------..-......------------------------------------------=------------------------------ <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, Statjilawrid rules and regulations of the San Joaquin Local Health District./ dor Contractor(Signed) --- ----- - ------------------------------------------------------- --� /By:----- ---- - ------•-------------------------(Title)------------- -_---------------- <br /> --- <br /> (Plot plan, showing size of loft, location of system in relation to Wells, buildings, etc., can be placed on reverse side). <br /> y_ .FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-- DATE 'G <br /> --------------------------------- <br /> -REVIEWED BY------------------------------------------------------------- -----------------1------------------------------------ ------ DATE----------------------------------------------------------- <br /> BUILDINGPERMIT ISSUED---------------------------------- ------------------------------------------------------------------- DATE-------------------------------------------------------------- <br /> Alterations <br /> ------------- -'------------ <br /> Alterationsand/or recommendations-------------------------------------- -- ------------------------------------------------------....-------------------------------------._-. ------------------ <br /> -------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------- <br /> ---------------------------------------------------- <br /> --------------------------------------------------------------------------- ---- - ------------------------ - ------- <br /> O -jr'y <br /> FINAL INSPECTION BY:. �/I /ham-' .l tlC"----------------- Date--------------------- f <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Ha=elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVIINED B-59 3M 3-'63 F.P-CC- <br />