Laserfiche WebLink
FCR OFFICE USE., <br /> .5'"- <br /> ------��=------- � -�: � �° APPLICATION FOR SANITATION PERMIT Permit.No. _ .. ....--_ <br /> ------------------- ------------ -------------- (Complete in Duplicate) F <br /> This Permit Ex fres 1 Year From Date Issued Date Issued ---./31� <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....... ---_ e <br /> ---------------- ------------------------------------------ --------------------------------....................------------------- <br /> Owner's Name.. ..... r .. ----------- --•---- ----------------------- ------ Phone.------......---------------------- <br /> Address l ---------------------- <br /> ----------------------------------------- <br /> ---...... <br /> --------------------------------- <br /> -...... <br /> --•----• --------------- <br /> -......... <br /> Contractor's Name--•----------- --x�. .T--S------------------------------------------------------------------------------------------. Phone................................... <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: --/____ Number of bedrooms _2-- Number of baths -1----- Lot size ...f - <br /> Water Supply: Public system Community system ❑ Private❑ Depth To Water Table .Z.:Pft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> Previous Application Made: (If yes,date------------ ---""_) No ff�' New Construction: Yes [!( No [5�-'FHA/VA: Yes ❑ No ZL -- <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: .r <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> r <br /> epc y/ Distance <br /> nearest from ` ell________ Distance from foundation---__.............Material----------•----------------------------- <br /> Noof compartments <br /> _ ___ __ e ; -- <br /> Liquid depth---_______--.-----------._Capacity_.....--..------___.._. <br /> Dispos ielc: l Distance from nearest well-------------"-"-Distance from foundation.........-..........Distance to nearest lot line----------------- <br /> ) Number of lines-----------------------------------Length of each line----------------------_------Width of trench----------------------------------- <br /> Type of filter material-------------------------Depth of filter material-----------------------Total length--------------------------------- ........ m "' <br /> Seepage Pit: Distance to nearest well_-------------------Distan m fo ndation_-_l_d--�_-._-_.Distance to nearest lot line__5..:�...-.. <br /> [ Number of pits_.-_-.f-------------Lining materia.../_ _-..Size: Diameter-_'�,�-"------.-Depth------��"'.`..-__.•...-- <br /> � ~ <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):--------'------------------------------------------------------------------•------------------- -•------•-------••------•-----•-----------•------------- <br /> f <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 reguiat' s the San Joaquin Local Health District. <br /> (Signed) ------ ---- - -- - -------•---------------------------------------------------------------(Owner and/or Contractor) <br /> By:----------------------------------- --- •. ----------------=--------------------------_--------------------------•(Title)----------- --------------•---- ...... --------- <br /> (Plat 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' r <br /> APPLICATION ACCEPTED BY-- ------- ------ -t -------------------------------------• --- DATE------ <br /> REVIEWEDBY ----------------.----- -----------------------------------------.. DATE----------------•--------... <br /> BUILDINGPERMIT ISSUED.........-•------------------------------•---------<------ -•---------------------- ,------ ...------ DATE.-------------------• ----------------------- <br /> Alterations and/or reco mendations:_----- f� —c ` ' r <br /> FINAL INSPECTION BY:.--.'1V__,- -4� ------------------ Date-------------------------------- -----•�J'~-----------..-...-----------...-. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9fh Street <br /> Stockton,California Lodl,California Manteca,California Tracy,California <br /> E3 9 REVISED 8-59 2M 5-62 ATLAS <br />