Laserfiche WebLink
..---__FOR OFFICE USE: L7 <br /> s - - <br /> ---•-- 7 <br /> `------ ----------------- -------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. LE........ <br /> -• <br /> - ----------------------------------- -------------- (Complete in Duplicate) / <br /> ---- --- This Permit Expires 1 Year From Dafe—lssuad Date Issued ...... Z.... <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 eP�lication.is.made in compliance with County Ordinance No. 549. <br /> [`Cb_Q�ie Lr made, <br /> 0.4e-. <br /> JOB ADDRESS AND LOCATION,, - .. ��� �� 1 -_--------------_-_-_-------- <br /> ................. <br /> Name------- <br /> Address_ <br /> ----- Phone................. ------------- <br /> F <br /> Address......................I.A-1 <br /> .............._--------- -- <br /> Contractor's Name }...... _._.. -------- .. <br /> ............................ ................. Phone................................... <br /> Installation will serve: Residence];� -Apartment-House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: J---- Number of bedrooms -__ Number of baths 1--__ Lot size .11&t-__ �_______________________ _ <br /> Water Supply: Public system ❑ Community system ❑ Private Pd Depth To Water Table 6-Q-. ft. <br /> Character of soil to a depth of 3 feet: Send~Grovel Sand Loam,4 Loam Cla `Adobe Hard an <br /> P t ❑ ❑ Y FY ❑ Y ❑ ❑ P ❑ �. <br /> Previous Application Made: (If yes,date------_-------------) No J�j New Construction: Yes,® No ❑ FHA/VA: Yes ❑ N0�71` <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: .s <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well-- 6-_`=_Distance from foundation- ----------Material- <br /> ea No. of compartments:. " ze.......3_Irlt: Liquid`depth_______y______________ <br /> Disposal Field: Distance from nearest`well_.q---------Distance from foundation.Z-Q.............Distance to nearest�Ippt line__�t~_......... <br /> Number of lines______' _._ ___ Length of each line-----,��_. _ Width of trench._3�r-. :_!'................... <br /> Se #: Distance e of }Iter eaten Depth of filter material_., d --------------Total length---_26___________________________ C <br /> est wel__4_ Q_t_______-Distance from foundation---/0!�:____.,Distance to nearest lot line. ............ <br /> Nu o - s__}- ---------- ----Lining material- ---------Size: Diameter_32�1`--_.-----Depth--,/-;------------------------ <br /> Cesspool- Distance from nearest well _________-------Distance from foundation--------------.----.Lining material-------------------- <br /> Size: Diameter-_1 Capacity----------------------------gals. rn <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_-------------------------------------------- 1 . <br /> t <br /> El to nearest lot line ----------------------------------------------•----- <br /> fQ - <br /> Remodeling and/or repairing (describe):________�f1 <br /> ---------------------­- ------------------------------------------------------------------------ <br /> ----------- <br /> I <br /> •------•----------------------•---------------------------••--------•------------------------------•--------------•------------------------_-..--.---.--------•---------------••------•---------------------------------- <br /> I hereby certify that I have repared is application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, an and re ations of the San Joaquin Local Health District. <br /> (Signed)--------- ----------------------------------- ------------------------------------------------------------------------------------------------(Owner and/or Contractor) <br /> CBY:.......................--------------------------------------------------------------------------------------------------------------(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------------------------------------------------------------ <br /> BUILDINGPERMIT ISSUED------•----..--'------------------------------------------------------------------------------------. DATE-------------------------------------------------------- <br /> Alterationsand/or recommend'ations------------------------------ -•------------------•------•----------------------------••------••------------------•------•---_..._..----•-----••------------- <br /> --•---•-------------------------------- ---- <br /> ----/ ------ <br /> -----------------------------------•---------- ----------------- - <br /> ------------------------------ <br /> ------------------------------ ------ -------------------------------- ------- ------------- ------------------------------------------------------------------------------------------------------------------- ------ <br /> FINAL INSPECTION BY: �„y ---.-_-__----...- <br /> ------------------------------------------------------------- <br /> _ j <br /> f SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street # 300 West Oak Strut 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 9-59 2M 5-62 ATLAS <br />