Laserfiche WebLink
17, <br /> ' APPLICATION FOR SANITATION PERMIT -=Permit No. ��fa_ <br /> rya i � -.-.------ <br /> a 1 <br /> (Complete in Duplicate) / Date Issued --- / S�/__l?.d <br /> Application is hereby made to the San Joaquin Local Health District fora 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-_5_1�?CA -----I-A....... -------------------------------------------------................................. <br /> Owner's Name �J ------------------------------------------------------------ Phone------------------------------------ <br /> Address-------------!]_____- --- ---V__ry--- .. <br /> Contractor's Name---------------------------- --- ---- - --------------------------------------------------------------•---------- Phone----------------------------------- <br /> Installation will serve: Residence Apartmeg House'❑ l ial E] Trailer Court E] Motel ❑ Other E]Number of living units: -__(__- Number of bedrooms .9__umb of baths ----I--- Lot size __•____ -------------------------------------------------- <br /> Water Supply: Public system [:] Community system J� Private E] Depth to Water Table ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ] Adobe t] Hardpan ❑ <br /> Previous Application Made: Yes ❑ No New Construction: YesNo ❑ FHA/VA: Yes E] No 1 0 <br /> i <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or`cesspool permitted if public sewer is available within 200 feet.) <br /> /UI�r..�-b --------- <br /> Septic Tank: Distance from nearest well_�_�Q._ Distanc from foundation----_______________.M`4er`al_..._.____.____.._.______._r_ _ <br /> No. of compartments..__. '.______._____Size__ p _�.._ Liquid depth___.-T._ �,--____Capacity_[__ _Q_�.___. V" <br /> Disposal Field: Distance from nearest well r_ __Distance from foundation._ZIP......_Distance to nearest lot�}11n�e___-�____-____-- <br /> [�' Number of lines-------3_--_--_.�_----__"___.�_ Length of each line3_Q_'30_`J?----Width of trench._-A-- °'-------------------- <br /> /1 Type of filter material-1!Ty' 1�----Depth of filter material----Ll-------------Total length___--�7-..?_-_-__--_--__-___-_____-•__-- <br /> Seepage Pit: Distance to nearest well--/_________---------Distance from fou ation---____t�_.........Distance to nearest of line_-- ...._... <br /> Number of pits____.___._____.__LrtrlRt�'Tna'I2PI�1` _ __V,Size: Diameter_______________________Depth__: /_ _ _ __.0_--_---_-_-___ <br /> Cesspool: Distance from nearest well- _-_-_____-__ nce from,foun tion Li ' material_ <br /> ❑ Size: Diameter------------------------- ----- -• L ui .0a i ---- -gals. <br /> Privy: Distance from nearest well_________________________________________________Distance from nearest buildinv----------------------------_____--_._.-. <br /> ❑ Distance to nearest lot linye-------------•--------------------------------------------------------- ------------------------------------------ •--------------- <br /> Remodeling ,and/or repairing (d stribe):_-.01------------- - !li1.t "t -Gr2/----------------------- <br /> - <br /> - ---- - ----------- -------------------------------------- <br /> ---------------------------------------- ------_--_ ---- ------ --------------------------------------------------=----------------------------------------------------------------- <br /> I he certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinanc s, ate laws, and ruleaTions <br /> of the San Joaquin Local Health District. <br /> (Signed).-9 )-- - - -- ----- ---��-�'"�--------------- -----------------------------------------------------------------(Owner and/or Contractor) <br /> •---------------------- <br /> --(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 /> REVIEWED BY-------------------------------- ­-------------------- DATE------, ?-�-- --------------- <br /> BUILDING PERMIT ISSUED----_------------------------ — --------------------- DATE-------------_-------------------------------------------- <br /> --------------------------- <br /> Alterations and/or recommendations----------------------------------------------- --------------------------------------------------------------------------------------------------------------- <br /> ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> --------------------------------------------------------------------•---------------------------------------------------------------------------------------------------------------------------------------­------------ <br /> ­1----------------------------------------------------­­----------------------------------------------- <br /> ------------- ------------..-•---------------------------•----------------------------------------------------------------------------•-------------------------------------------------------------------------------------------------------------- <br /> ------------ - ----------------------------------------------------------------------•----•---------------------------------------------------------------------- <br /> FINAL INSPECTION BY------------------ ------- Date.-------------- r --------------------------------------- <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 ; Revised 1.57 F.P.CO. <br />