Laserfiche WebLink
FOR OFFICE USEt <br /> iv APPLICATION FOR SANITATION PERMIT <br />(Complete in Duplicate) <br />This Permit Expires 1 Year From Date Issued <br />.pplication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein dscribed. <br />This application is made in compliancl ith County Ordinance No. 549. <br />JOB ADDRESS AND L CATIO <br />Owner's Nam .. . .. .... <br />Address .- 0 . <br />Contractor's Name <br />Installation will serve: Residence <br />Ca-A-Ai\i' ez1 <br />,31 <br />Apartment House 0 Commercial 0 Trailer Court 0 Motel 0 Other 0 <br />... <br />0i3 (CD <br />Permit No. <br />Date Issued <br />e9 f)/P.6 <br />El P.A- dert-xzradi <br />Phone.. <br />Phone <br />Distance from nearest well.... ...CO!. <br />Type of filter material 4 12. <br />,...Distance from foundation. /I> <br />Length of each line....... <br />Depth Depth of filter material.. ...[.9., <br />Number of lines <br />Number of living units: .1... Number of bedrooms 45. - Number baths .../... Lot size Eel <br />)0 t Water Supply: Public system 0 Community system 0 Private Depth Water Table . 10 i T. <br />Character of soil to a depth of 3 feet: Sand 0 Gravel 0 Sandy Loam Clay Loam 0 Clay 0 Adobe 0 Hardpan 0 <br />Previous Application Made: :If yes, date ) No 0 New Construction: Yes 0 No 0 FHA/VA: Ye <br /> NO 0 <br />TYPE OF INSTALLATION AND SPECIFICATIONS: <br />(No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br />Distance from founsi;etion <br /> Size nt fix /Liquid depth <br />Material ee,4-4L--1-4- <br />Capacity.... .4 xpr. <br />Distance to nearest lot line.i <br />Width of trench <br />Total length length / OP <br />_Distance to nearest lot line <br />Depth' <br />Distance from nearest well Distance from nearest building.. <br />Distance to nearest lot line ...... ... ......... ..... <br />Distance from nearest well <br />No. of compartments <br />Seepage Pit: Distance to nearest well Distance from foundation <br />0 Number of pi.h Lining material Size - Diameter <br />Cesspool: Distance from nearest well Distance from foundation <br />0 Size: Diameter Depth Liquid Capacity .............. <br />Lining material <br />.•riyy: <br />0 <br />Remodeling and/or repairing {describe):. <br /> <br />4pe 64.14 <br /> <br /> -e- <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, rules and regulations of the San Joaquin Local Health District. <br />of lot, location of system in relation to wells, bu dings, etc., can be placed on reverse side). <br />(Signed). <br /> <br />By• <br />(Plot plan, showing si <br />---(0wrreend/or Contractor) <br />FOR DEPARTMENT USE ONLY <br />APPLICATION ACCEPTED BY.. DATE.. <br />REVIEWED BY DATE. <br />BUILDING PERMIT ISSUED DATE . <br />Alterations and/or recommendations: <br />FINAL INSPECTION BY:.. <br /> <br />Date <br /> <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />1601 E. Hosithon Avo. <br />Stockton, Gallfornks <br />co 9 REVISED 10-59 31,4 3-'63 F <br />300 West Oak Stroof <br />Lodi, California <br />)24 Sycarnor• Stroot <br />Man .ca, Ca I i f orn ia <br />205 West 4th Street <br />Tracy, California