Laserfiche WebLink
APPLICATION- FOR SANITATION PERMIT Permit No. '7 <br /> (Complete in Duplicate) <br /> Date Issued _ S/ 3 <br /> Application is hereby made to the Son Joaquin Lo'cal 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 /> C) 6-� <br /> JOB ADDRESS AND LOCATIONV_( <br /> AK,3 s�-7 <br /> ------ ------W_ <br /> Owner's Name-------- ------- <br /> ----- - ------------- ----------- <br /> ---------------- ------------------- <br /> honp <br /> Address---- /�� ----------------- <br /> - ------------ <br /> - -------------- <br /> ----------------------------------------------------------------------------------------- ----------- ---------- <br /> ----------- --- ---------- - -------- :-------------------------- -------------------------------------------- <br /> Contractor's Name Phone f:77 ___4/ov---------- <br /> Installation will serve: Residence Apartment House ❑0 Commercial El Trailer Court El MOf.61 ❑ Other <br /> ❑ <br /> at 7 <br /> Number of living units- Number of bedrooms Number f baths Lot size --- ---q <br /> Wafer Supply: Public system El Community syste' ---- --------------------------- <br /> m El '.?rivafe Depth�� to Water Table <br /> Character of soil to a depth of 3 feet: Sand Gravel Ej' Sandy Loam E] <br /> Previous Application Made: Yes Clay Loam E] Clay D Adobe �ardpan Ej <br /> i No E!r New Construction: Yes No El <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank,or Cesspool permitted if public sewer is available within 200 feet.) <br /> Septic T nk: Di.stance from nearest well_----"l6_0 Disfance'fror <br /> 9 foundation------/-I!------Material <br /> No.. of compartments--------- Liquid clepfh__.�.�4_ ------------------------ ----- <br /> -Disposal �,elcl: ---------'Ca pa city-_79a <br /> Distance from nearest well.... ---Distance from foundation.---- stance to nearest lot line 15— <br /> Number of �ines__._, -----�'S------Di <br /> I-----Length of each line-----/ <br /> W __*tO ;j----------- <br /> Width of trench-----c -------------- <br /> T <br /> ------Depth of filter material------ length--'ype of fi0fer maferiaL_ <br /> -------------------- <br /> Seepage Pit:' Distance to nearest well--------------------- Distance from foundafio�n----------- -to"- <br /> D Number of pits____ ___________"-_ ---- .._-._-..Distance nearest lot line-"---.--.- <br /> ..W <br /> e----- ----------- <br /> Cesspool I----------------Lining material-----------------------Size: Diameter------------------ ----Depth....----............. <br /> Distance from nearest well--------------- Distance from found -------- <br /> ,,,r foundation <br /> ____________________Lining e: Diameter-------I------------------- -----------Depth--------------- -------Lining material_---_-_____.-_______"--------------- <br /> Privy:- Distance from neat well ---------------------------------------Liquid Capacity Capacity--------------------- ----gals. <br /> 0 Distance to nearest lot line.:, -----------------------------_Disfahce from nearest building.----------------------------------------- <br /> ---------------------- <br /> ---------------------------------------I—------------------------------------------------------------------ <br /> Remodeling and/or repairing (describe):_____.._-_______-____ <br /> ------------I-----------------•-••---- -------------- ------------------ <br /> ------------­-------- ------- <br /> -----------------------------------------------I---------------------------------_------------------------------------------------------------------------------------------*--------------------------------------------------------------------------- <br /> I - - --------------------------------*--- <br /> ----------------------------------------------------_------------ .----__---------_­---__------__------__-----__-------•----- ---__------------------------- -----------•-------------_-_----_------------------------.---.------------------- <br /> .-I---------------- <br /> --- <br /> - <br /> -.1 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 /> (Signed)----------------------��� I <br /> --- ----- <br /> By:------- - ----------------------------------------------------- -------- and/or Contractor) <br /> -------------0—AZ--•---- <br /> ------------------------------------------------------------------------ <br /> (Plot plan, showing size of lot, location -(Title)---ef_� <br /> of system in relation to wells, buildings, etc., ------ -------------------------------- <br /> can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-------•------ ----------1 <br /> REVIEWED BY-, -- ------------------------------------- <br /> DATE <br /> ---------------- <br /> -------------------------------------- Y64 <br /> BUILDfNG PERMIT ISSUED -------------------------------------------------------------------------------------- DATE------------------- -------------------- <br /> Alterations and/or recommendations:--................................................*-----------------------------------*-------- DATE----------------------------- -------------------- <br /> ----------------------- ---------------------------------------------------- <br /> ---------------------------------------------------------------------------------------- . --------------------------------------------------------- <br /> ------------ --------------------------------------------------------------- ----------------------------I---m------------------I--- <br /> -----------------------------------------------------------------------------------------------I------------------------------------------- -------------------------------------------------------------------------------- <br /> ---------------------------------------------------------------------L-------- ------------------------------------------------------------------ ------------------- <br /> ---------------------------------- -------------------- ------------------- ----- -------------------------- <br /> ----------------- ------------- --------------------------- <br /> FINAL INSPECTION BY:.--- - - ------------------- ---------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> ------------- <br /> 130 South American Street I <br /> 300 West Oak Street 132 Sycamore Street814 North "C" Street <br /> S+ock+on, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M 10-52 Revised W-21oD <br />