Laserfiche WebLink
FOR OFFICE O f-7 Le—Q j—f�'l�} — q - - t O <br /> _________________________________________________ APPLICATION RA SANITATION PERMIT Permit No. .,1.. .. <br /> ------------------------- --------------- -- ----- (Complete in Duplicate) Date Issued .-- - <br />--- ----------------------------------------------------- This Permit Expires 1 Year From Date Issued <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 AND LOCATION._.../1)1­7------Sj�� -ti'__1.�G�....--------•----•--•----••-------- ..................... ---••--•- <br /> Owner's Name ---- P ne .................... <br /> -- <br /> P � <br /> Address--•---......,1_Q_.1 D 0..---- _ '....-- ---- ------ #.......................... <br /> Contractor's Name------- -- ---•-•------------------------------------------------•---------------------------------...---------._....-------- Phone-- ............................... <br /> Installation will serve: Residen q Apartment House 0 Commercial ❑ Trailer Court ❑ M tel ❑ Other ❑ <br /> i <br /> Number of living units: ---/.. Number of bedrooms ._I____ Number of baths ___l___ Lot size .............X..//.I.-/.:;U............. <br /> Water Supply: Public system ❑ Community system W Private ❑ Depth to Water Table I.Q.- ft. <br /> Character of soil to a depth of 3 feet: Send ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay Adobe❑ Hardpan <br /> Previous Application Made: (If yes,date---------------------) No�d New Construction: e , 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 k: Distance from nearest well_________________Distance from foundation....................Material............._................................... <br /> No. of compartments__________________________Size................................Liquid depth..........................Capacity....................... \ <br /> Disposal He : Distance from nearest well_.b.B-Q-_-Distance from foundation__ .Distance to nearest lot line ........... <br /> Number of lines.............. ._Length of each line____________ _ Width of trench.._,rZ._._ <br /> IL <br /> Type of filter materialz __.___. .. . Depth of filter materiaL__�/,�_, 'Notal length......... ..... ........................ <br /> Q - <br /> -- trench....A....-7----------------- <br /> Type <br /> Pit: Distance to nearest well______________________Distance from foundation....._..............Distance to nearest lot line................. <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 /> Privy: Distance from nearest well____________________________--------------------Distance from nearest building.___._.__..__.______._._......_.....__._.. <br /> ❑ Distance to nearest lot line............................................................................................................ <br /> Remodeling and/or repairing (describe):----- - - - - ------ -1111c"r-_ x ...... <br /> .............. /1'- - ....&I 4�-- -- ------- --- --- -- •------- ---- •- -------------------------- <br /> ------------- ... ---2have <br /> ------ <br /> ----- -------------------------------- --------•--.....................•------- ------•----..................................................... <br /> hereby certify at I repar d th application a that the work will be done in accordance with San Joaquin Countyordinances, State laws, andnd gula ns the Sa Joaquin Local Health District. <br /> (Signed)/-__... _..` . .. .,< '/ ----------------------•------------..............................(Owner and/or Contractor) <br /> By:....................................................................................................................................(Title)------------------------------------. . <br /> (Plot plan, showing size of 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......................................................... •----------------------•-------•---•--- DATE........................... <br /> REVIEWEDBY................................................................ --- ---------- ----------- DATE...... �„2. ..� ��.................. <br /> BUILDING PERMIT ISSUED.. --------------------------- DATE............................................................ <br /> Alterationsand/or recommendations---------------_---- --------------- ........................................................................................................................ <br /> --------------------------------------------.................................f---�'-------------------•------------------------------------------------------ -•-----------------------•-----------------------•--••------------•--- <br /> FINAL INSPECTION BY:........... ...... Date Q__._- k? �""",. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 209 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> 14 9 ret VISED 9-59 RM 6-61 ATLAS <br />