Laserfiche WebLink
Metadata
Document management portal powered by Laserfiche WebLink 9 © 1998-2015 Laserfiche. All rights reserved.
APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) Date Issued a-lz7-5-!5� <br /> Application is hereby made to the San Joaquin Local Health Dist rict for a permit to construct and install the work herein jd7�ibed. <br /> This application 'is made in compliance!pw'ith County OWrdin ce No. 549. <br /> JOB ADDRESS AND �OCATION,00 4 <br /> Owner's Na 6p-lk�� <br /> AddressWM -.2-------- --- -------------------- ----1-1---------------- ------------------------------------------------------------------------------------------------- <br /> Installation will serve: Residence 4A arfment House E] Commercial E] Trailer Court Motel E] Other E] <br /> Number of living units: -I-- Number of bedrooms Number of baths ---I--- Lot size <br /> ------------------------- <br /> Wafer Supply; Public system El Community system E] Private 9 Depth to Water Table -+ff. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel [-] Sandy Loam E] Clay Loam El Clay El Adobe El Hardpan El <br /> Previous Application Made: Yes 0 No K New Construction: Yes IV No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic fank or cesspool permitted if pulplic sewer is available wifh;n 200 feet.) <br /> Sept' Tank: Distance fwell------� jQ <br /> Dispo al Field: Distance from 6-0- le"frn��� -5 <br /> Seepage Pit: Distance to nunns+ weU�''----'—Distance from foundation <br /> F-1 <br /> n�u,�� �� Snv'—''—'— <br /> F-1 Numbe, of pits----------------------Lining material-----------------------Size: Diameter._--------Depth------.---- <br /> Ceopoo: Di,h,noa from nearest well----------------- from foundation '—''''--Lining material ''''—''—''—'��—~« <br /> [] Size: Diameter ---- -------------------------------Depth--------------------------------------------- ------Liqu�6 Capacity---------------------------- <br /> Privy- Distance from nearest wc|�'—''--'---''—'''—'D|stanco from nearest building-------------- <br /> Distanceto nnon,s+ |o+ line----------------------------- ---------------------------------..-------------------- <br /> Remodeling and/or repairing (6eocribe):--------- ------------------------- ---------------------- —__''--_—.__.__'—'''____.______________ <br /> - ------'--'-------''---'-----'---'--'-------'--'--'----''---------------'' <br /> ---'-------'''—''----''--''—'''---'-----''--'—'---'''----'-------'--'----'---'---'---' <br /> --�—'''__—''''—'-'------___—.'--_—._--__'_—__'—'__.--_'--''—_—''--'--'—''—''___'—'''—'—'—''—' <br /> 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 /> —' -- --------------------------------------------------------- ---------------------(Owner and/or Contractor) <br /> By:-------------------------------------------- ---------------------------------------------------------------------------------------Tifle) ------------ ----------------------- <br /> � <br /> (Plot plan, showing size ze oflocation of system in ro|a�on to wells, buildings, e+o` can be placed on reverse side). <br /> APPLICATIONFOR DEPARTMENT USE ONLY <br /> ^ ACCEPTED'^~ ~'-----------' ----------------------------------------- "~'E— <br /> REVIEWED 8 <br /> BUILDING PERMIT ISSUED—.-------- --------------------------------_-------.. DAT -------------------- <br /> Alterations and/or recommendations:---]L.------ --- ---------------------------------------------------------------------- ------------------------------------------------------------ <br /> ---------------------------------------------------------------'-----------------'-------------------------'--'' <br /> _'_'_—''--'_''''—_''''—'—'''--''--_�'_--''---'''_—'''—_''''--_''—'-_—�'—_'--_'''--'__.'—'—'- <br /> ----__--------__------____---------------_��____---___---______----____-------___---------__� ------------------------------------------------ -------------- --------------- - <br /> —'—''—'''----'''--''--''' '_'—'''''—''''''—'''---'''---''— ------------------------ <br /> ------------- <br /> ''---. <br /> F|N/\L |N3PB�T|{}N 8Y�----- ^�'.--~~ —.--�---. D�+o---y-�7�~�-���~`� ---_--�--.� <br /> SAN JOAQ0NLOCAL HEALTH DISTRICT <br /> mo so.m American Street 300 West Oak Street ox Sycamore Street ow worth ''C^ Street <br /> $" kt=. California Lodi, California Manteca, California Tracy, California <br />