Laserfiche WebLink
'"011 cedo r <br /> APPLICATION FOR SANITATION PERMIT Permit No. 7 <br /> ....................... <br /> (Complete in Duplicate) Date Issued�.72._.r4 <br /> Application <br /> is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This <br /> i <br /> application is made in compliance. ith County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION dA4,� ........ <br /> ........... ----- .............. <br /> 6 ......... <br /> Owner's,1`4ame---------------[.tel 0 <br /> ...•.... ---------------------­----- ------------- <br /> - ------- ------- <br /> . ...................... ..... <br /> Address.lif a49.......okeo_&1111�--- - - ------ .................. --------------_--............................... <br /> Contractor's Name............................... ........................................---------------------------------------------------40............... Phone------............................ <br /> Installation will serve: Residence Apartment House [-] Commercial F <br /> ] Trailer Court E] Motel [] Other <br /> Number of living units: ...J_ Number of bedrooms -__L Number of baths .../-- Lot size --------1w--0--_!\__1_D_A;!....................- <br /> Water Supply: Public system ❑ 'Community system I-A Private [] Depth to Water Table ........ ft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam E] Clay Loam E] Clay 0 Adobe[-] Hardpan n <br /> Previous Application Made: Yes R No,& New Construction: Yes A, No [j <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: f <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well---9.00__"Distan# fZpn fxnqp�ion...Lo M t - I <br /> ............ a'er' <br /> _4�---------Capacity....6511-------------- <br /> No. of compartments-----------A--------Size---------r....0--------5---Liquid depth--------- <br /> Disposal Field: Distance from nearest well.3.0.0....Distance from foundation-----/.10........Distance to nearest lot line-_-._--- <br /> of lines------------I-------------------- ength of each A line------6_0---Fe.l----Width of trench----,I--*- ----- <br /> --- - ---- -------------- <br /> Type of filter maferial__S_r__A1VV-4epth of filter material_.___ - ------------Total length......&C?.......................... <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line--........I....... <br /> ❑ Number of pits______________________Lining material-----------------------Size: Diameter........................Depth-------_------------__------ <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- <br /> ❑ Size: Diameter- --------------------------------Depth------_---------------------------------------,-Liquid Capacity .----- ---.-------gals: <br /> _ <br /> Privy: Distance from nearest well-___..._------------------------------------------Distance from nearest building_____ ........... ---------------- <br /> ElDistance to nearest lot line----- -/------------------------------------- --•------------------- ------------------------------------------------------------- <br /> Remodeling and/or repairing (describe):...4.0-e-PL-Ci. ........................................................... ....................... <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 County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health,District. <br /> (Signed)-•---- •I. . ........ .....------ -- ------- -------------V-----------------------------------------------------------------------------------------(Owner and/or Contractor <br /> 1 -7, <br /> By:.................Z... .. ............ . ..... .........I <br /> ­ -­--------------------------------------------------------------(Title)--------------------------------------------------I-------------- <br /> (Plot plan, showing six f lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------------------------_- -----------------___ <br /> ------------------------------------------- DATE--------------- �---------------------- <br /> REVIEWED � -5- ---BY----------------------------------------- --------------------- - ------------------------------------- DATE......��rn -- ------ ----------------------------- <br /> BUILDING PERMIT ISSUED..................................... .......... <br /> �4sfl�&k--------------------------------- DATE------------------------------------------------------- <br /> Altera and/ r recommen4ations:------ ----------------j---�r- --- ........................................................................................................... <br /> .......... ..... ......... - -- -----­--------­-I..................................................................................... <br /> ......... <br /> ------------------------------------------------------........ -------------------------------- ................................................................................................................... ....... <br /> ....................................------------------------------------------------------------------ ......... <br /> ----------- ---------------------- ----- -- =.......... .. . ........................................ -------------------------------------------------------------------- <br /> ----------------------- <br /> FINAL INSPECTION BY=----------------- Date------ --------------------- --- ------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M 10-52 Revised W-2100 <br />