Laserfiche WebLink
APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) 6 <br /> Dat Issued __ _�,�.. <br /> Applica*ion°is hei•eb-y]I made.to the.San Joaquin Local Health Qistr'ict for 6a per'.mFt,to construct and.install the'work herein described. <br /> This application is made in compliance`with County Ordinance No. 549.E f 3 t <br /> JOB ADDRESS AND!LOCATION.._y_:__'_:__-_ ':___-- .. <br /> Owners Name <br /> • 4 V == hone .: .. <br /> a '- � r <br /> Address II ------- { --------------------- <br /> - <br /> Contractor s-,Nama L--:--.--- one------••------------------ <br /> ----- <br /> : T p i r - Ph. <br /> Installation will serve: Res dence Apartment-House ❑ Commercial ❑ Trailer Court ❑ - Motel ❑ Other ❑ <br /> Number of living units __. Number of bedrooms <br /> Number of baths' t._�Lot sizer • - -�-'----------- ----------- <br /> r + , - j r ' i <br /> Water'SuppIy.. Public system em ,El Private be' pth',to".Water:Table" <br /> Chararcter of,soil to a�depth'of 3'feet Send: Gravel C] Sandy Loam ❑ da Loam Clay ❑ IAdobI Hardpan ❑ <br /> Previou's•Application' Made: :Yes E] No New Construction, Yes No Q. i <br /> TYPE OF,INSTALLATION AND..SPECIFICATIONS: <br /> No septic tank or.cesspool permitted if'public sewer is available within 200 feet.)Lj <br /> . Y <br /> Septic Tank: ¢T!�te f"nom nearess well ------_---.._-Distance from foundation -._-_- �----iZeriai__--- _`---------------------------=------------ <br /> 4 r y ' <br /> compartrneh#s -----.:.: Size--------- ------- ---- ----Liquid depth _._ --Capacity..........._---____--- <br /> Disposal-Field: +* Distance•from nearest'well _..._.:-----' Distance from foundation_,_.,___ �-:-. :Distance to nearest lot line____ _________ <br /> . r . �;mber•of lines---- -;__F --------------, Length of eachlline--------------------- Width of trench.-- __-------------------------- <br /> T' T etof filter material:_--- :-: : Depth of filter material....----- f _:Total length----------------------- ------------------ <br /> P gPit-, <br /> r .Y , <br /> r -r <br /> See a e Pit-, Distance,fo.nearest well Dsstance from foundation Distance to nearest lot line_________________ <br /> Number,of pits _ t :LEninrq material-_ - 4 ._ Size. Qiame�r :?__________ ______Depth ._ <br /> _ - 1. 4 _ �j .___ ______ <br /> Cesspool:. " " -Distance from nearest well_._l .___ __Distance fr fo"nd: on ._ Q _--__ Linin material_-'-a""�" <br /> r_f- -_De th_------ '. -------`... Li uid Ca acit gals. <br /> r it , <br /> { - . _ 1 E �.}� r - ,fes _ „ ,,. Y I.-} --- �l p -y- --•--•- - -- <br /> Privy: r Distance' rom`t t ' Di"stance fromnearest'building Size: Diamete <br /> ' nearesf well _L_._.... � --------------------------- --- <br /> ` "w#.+"�..� DisfaEnce`"to`ne'arest"lot !me i ».ri»";� �.-r-- <br /> } ` r - ! ' r$ <br /> "" <br /> Remodelingand/orrepairing r---------------------- -----------_:------• ----- <br /> r ----------- ------••---- -•_•_-_•_-_-_-_-_-_•_-_-_--------- <br /> __ _____________ ______________ --------- <br /> ------------------------------------------------------------------- _--____--_-_ <br /> ` <br /> --------r- -.•_- -. - `-------- `--`-- _------ -- ----- ----_----------------------------- -- -- <br /> yy <br /> ------- --------------' - - -- - ------------ ----- •----------- - -------------------------------------------------- , <br /> I hereby certify-thaf-1 have prepared this application and-that the--+ or[r wl be done in accordance with San Joaquin County <br /> ordinances, State laws, a d rules e d reguiaftions.cf the San Joaquin Lccal Health District. <br /> t (Sign dj -- ------- <br /> -------- <br /> - (Owner and/or Contractor) <br /> r <br /> ---- (Title) = ----- <br /> (Plot pla_ showing sae_of.lot, locations of system relation to wells, buildings,.etc., can 6e' 'laced on reverse side). <br /> i <br /> FOR DEPARTMENT,USE ONLY', <br /> r <br /> 1. - t t .t. , _ <br /> - -'r s <br /> APPCATION ACCETED BY`_ - DTE <br /> --,-----:r ---------•------ QATE-----�,j <br /> D BY-_'­' ............. dDATE---------------------T <br /> _ -- -BUILDNG PERMIT ISSUED- ---Alteniafions and/or recommendations:-=--=_=-.------------ ------ -- --------------------- ---- ----- ----- ------------------------------------- <br /> -- ---- - L- <br /> t ! :.. ' -------- ---- ---------------------•--....... <br /> ..._.-.. <br /> �.,,-- ----- - = <br /> - <br /> I t a <br /> -- -- -- ----- - - - <br /> ---------`------+------- ------ - - <br /> -- -- -------- ------- ------------------------- <br /> _--..-. ------------------- f _. _ ..._ __. ._ -_--._.__. <br /> a 1Dat <br /> e - <br /> TION BY FI INSPE ------------- <br /> SAN <br /> """ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South Americ'a'n Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> EE-9-2M 145446 ATWOOD 12-54 <br />