Laserfiche WebLink
FOR OFFICE USE- <br /> --------------------------------------------------------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. n>Y <br /> -----------------------------­­---------------- <br /> ---------------7----------- ------------------ -------- *s,%, (C9p -in Duplitate) <br /> , plate • Date Issued <br /> --------------------------------------------------------- This Permit Expires 1 Year From D'a4WIsste"'d <br /> Application is hereby,made to the San Joaquin Local Health District for a permit to construct at�i,03,4,�or erein described. <br /> , 11 t <br /> This application is made incompliance with County Ordinance No. 549. <br /> 1-i LAC 04-�Ag—e)% <br /> JOB ADDRESS AND LOCAT N ...#---- - -- -------------- -------- .. ............... <br /> -Owners Name----• D -- --- ---------------------------------------------------------------------------.-, Phone--------_-------- ---------- <br /> -------de ...---- -.. - <br />:­�Adrss. <br /> ............... Phone...................._----------- <br /> Contractor's Name--------- ------ - --------- <br /> installation will serve: Residence Apartment House El Commercial E] Trailer Court E] Motel 0 Other [I <br /> Number of living units: j--- Number of bedrooms _/--- Number of baths I--- Lot size <br /> ------------------------------------ <br /> Water Supply: Public system [I Community system [I Private If Depth To Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel [] Sandy Loam eClay Loam [:) Clay E] Adobe❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date____________________) No E] Now Construction: Yes [:] No L] FHA/VA-. Yes [j No 0 k\J <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool pe:rmiffed if public sewer is available within 200 feet.) <br /> 'Septic Tank: Distance from nearest well_________________Distancefrom founclation--------------------Material------- ----------------------------------------- <br /> ❑ N6. of compartments--------------------.,__Size-------------------------------Liquid depth----------------------_-_Capacity--------•-----•---- <br /> Dispos <br /> apacity-------------------- <br /> DisposField: Distance from nearest well__��P P— -._Distance from'founclafion----/40.../----Distance to nearest lot/line_..s......... <br /> Number of lines-------------Z-------------------Length of each line---------60--/--,--------Width of trench--___X=--------- --------------- <br /> Type of filter material,,-- of filter material__lk" �-----Total length_____4&____________________________Distance to nearest well___-...____` --irom,foundation--------------......Distance to nearest lot line <br /> Seepage Pit: ��ance -1-------------- <br /> ❑ Number of pits----------------------Lining materia{[-.---------------_----Size: Diameter----------------------.Depth----.--_---------------------.--- <br /> c - " <br /> Cesspool: <br /> epth--------------------------------- <br /> Cesspool; Distance from nearest well-----------------Distance from foundation--------------------Lining material-----------------------------------N <br /> ❑ Size: Diamafer___�,--------------------_rn-7- 1)epth�....--------------------------------------------Liquid Capacity..--•--------;----p=--------gals. <br /> Privy: Distance from nearest arest well----------------I-I------------- <br /> ----------------Distance from nearest building------------------------------- <br /> -- - <br /> 11 Distance to nearest lot line----------------------------- - --------------------------............----------------------------------------------------------- N <br /> Remodeling and/or repairing (describe)---- --------------------------------------------------------•-•--------------••-•---•------I------------------------•-•---------------------•---------- <br /> L <br /> -- K <br /> ..........------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> iF <br /> --------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> -4 — <br /> ------------------------------------------------------- ---_­­---------------------------------­----------------------------------------------------------------------------------- -----------------------------�-L <br /> I hereby certify that I have prep.ared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances. Statplaws, and rules an regulations of San Joa5 'n Loc I Health District. <br /> ----------------------------------- Contractor) <br /> (Signed)---------- _- -------------------- - ----------- ----------- <br /> -- -------------- ------------ <br /> By:------------ ...... --- --- --------------------- '.(Title;)'-.__2 ---------=n--.'." <br /> (Plot <br /> --------:n--(Plot plan, showing size Of lot, location a system relation o wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY___04::941t,�- ------------------ -- --------------------------------------- DATE----- ...............--------------- <br /> REVIEWEDBY--------------------------------------------------------------------------------------------------------------------------I—. DATE----- ------------------------------------------------------- <br /> BUILDINGPERMIT ISSUED---------------------------------------------------------------_­----------------------------------- DATE------------------------------------------------------------- <br /> Atterations and/or recommendations_________________.._____._- ---------------------------- -—-—---—--------------------------------------- <br /> --------------------­ ........................ <br /> ------------------------- -----------:----------------------------- ---------------------------------------------------------- ---------------------------------- <br /> ----------­---------------------- ------------------------------------------------ --­------------------------­------------------------­----------------------------------­--------------------------------------;--- <br /> 1 <br /> ------------------ --------------------------- -------_­---------------------------------------------------------------------------------------------------------------------------------- 1z.11 <br /> ..... <br /> --------------------­--------------------------------------------------- ----- - -------------------------I------------------------------------­------------------------------------------------------------,'----------- <br /> r F <br /> w 1 j E <br /> FINAL <br /> ---------------- ------------ <br /> FINAL INSPECTION BY:_".............. ---- - -------------------- --------------- ......e5��---------------------- <br /> ----------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycarnors Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,CaliforniaTracy,California <br /> ES 9 REVISED B-59 2M,5-62 ATLAS <br />