Laserfiche WebLink
FOR OFFICE UII <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> ---------------- ---- - - ----------------- ------- <br /> ------------------------------------------------- (Complete in Duplicate} <br /> ,I, Date Issued <br /> ------------------------------------------------ This Permit Expires I Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Healfh 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 AND LJMATIONAe�-- -- ---- . ...... 6'k <br /> ,4� xal.4 <br /> Owner's Name-------- '--=----------------- Phone.................................... <br /> Address__.-- ----------------------------------------------------------------------------------------------I.................................... <br /> Contractor's Name--------------- .:n AP0,40,e-------------- •--•--------------•---•---•--`-=•_••-•-------­---------------------- Phone..........................•........ <br /> # <br /> Installation will serve: Residence 2T--'Apartment House E] Commercial F] Trailer Court F] Motel E] Other ❑ <br /> Number of living units: ---L Number of bedrooms -,?--' Number of bath's Z-. Lot size .1..04C-!'..................................... <br /> e ' "I <br /> Water Supply: Public :system E] Community system E] Private Depth -ro Water Table Zeft.r <br /> Character of soil to a depth of 3 feet:'Sand E] I P ravel Ej Sandy Loam ❑ Clay Loam C] Clay C3 Adobe 2'00IIHardpan <br /> RIO' <br /> Previous Application Made: (If yes,date--------------------) No 9?" New Construction: Yes Yes No E] 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 /> 0-1.1 <br /> Septic Tank: Distance from 'nearest well__,/,0d...Distancegf om foundatip�n_',,_./??........ <br /> No. of compartments---- ;i.-___Size "**-,_Liquid <br /> ---------- <br /> ............. <br /> Disposal Field: Distance from nearest ---Distance from�oundation-_-ZP._._._..Distance to nearest lot line-4....... <br /> each line..-.._7%0_�� Width of'trench.,;.-V_. <br /> Length of ------ <br /> Number of lines_... - 4. <br /> ..Type of filter material;.-~__ - ------Depth of filter m,t,,iai, , 9_7 --------Total length-----Z"__------------------ <br /> /I <br /> Seepage Pit: Distance to nearest well__IeW--- _Oistance from fopclation_.. ........-Dist W to nearest lot Jine__.w..... <br /> .-Siz6: Diameter----10---------- <br /> ----------Linin _rua -&A44- Depth--- <br /> Number of pits__... I g tqdqL/ ------------------------ <br /> b9;*1 <br /> Cesspool: Distance from nearest well-----------------Distance,from foundation.__.---______ ---_.Lining material______._______.____..________________ <br /> ❑ Size: Diameter--------------------------------------Depth,'__-,----------------------------------------------Liquid Capacify.r­................... .gal <br /> Privy: Distance from nearest well----------------------------•I------ ---Distance from nearest building------------ --------------------------I--- <br /> ElDistance to nearest lot line---------------------------- -------------------------------------- ----- --- -- ------------------*!-------!------------ <br /> Remodeling and/or repairing . . . .................. ........................................ <br /> -------------------------------------------------------------------------------------------------------------- ------------------- <br /> --------------------- --------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> --------------------------------------------------------- ------------------------------------------------------------------------------------------------- -------------------------------------------------- --- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Co • <br /> ordinances, State laws, and rull s and regulations of the,San Joaquin Local Health District. <br /> (Signed)---------------------- <br /> ____XW. <br /> 1,04-a �------ -------- ------------- r Contracto <br /> F <br /> By:-----------------------------------------------:---------------------- ------------------------(Title)- ------------ ------ -----_----- <br /> (Plot plan, showing size of lot, location of system iy[Ifion to wells, buildings, etc., can be placed on reverse side). <br /> OR'D PARTM�Nf USE ONLY <br /> APPLICATION ACCEPTED BY .... ---------­--­-----------­-- DATE.._.y.._../.. ........ ................ <br /> REVIEWEDBY..........-----_---------- ---------------- ---------------------------------------------------------------------------- DATE------ •---•--•------•----------•--------•--•-------•------- <br /> BUILDING <br /> ATE------------------------------------------------------------ <br /> BUILDING PERMIT ISSUED----------------------- -----?----------------------------------------------------------------------- DATE_..........._--------------------------------------------- <br /> ------ -------- <br /> Alterations and/or recporrimendatio-ris*-----------A-------------------------------- ------------ ---------------------------- ------------- <br /> n ------ <br /> ----- <br /> ---- --- ----- ----- - - - ----- <br /> ----------- <br /> ------ -------------------------- --------------- --------- --------------------------------------44A_­ ------- --vl <br /> FINAL INSPECTION BY:------- ----------------------------- Date------9----------- ----cz� ...I.I-- ------------------ <br /> - ---- - -------------- -- <br /> SAAN Jt0)AAQ0fVIIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak ivrost 205 West 9th Street <br /> M ..... <br /> Stockton,California �0dl,_Ca-l1fornla__]0 Calif.: <br /> Tracy,California <br /> ES 9 REVISED 8-59 2M 5-62 ATLAS"', <br />