Laserfiche WebLink
FOR OFF <br /> APPLItATION FOR SANITATION -,IERMIT Permit No. <br />- <br /> -____l_____________- ---- ---------- <br /> --------------- <br /> ------------------ -------------------------------------- <br /> (Complete in Duplicate) <br /> -------------—-- -------- ----------------------- This Permit Expires r, Year From Date Issued Date Issued --- <br /> Application is hereby made tolthe San Joaquin-Local-Health District for a permit to construct and install the work herein described. <br /> This application is macle,in..corriplian6e with Coun Ordinance No. 549. 1 <br /> ty <br /> ------------- <br /> OCATII --- ---------- .------ <br /> I <br /> ------&------------- <br /> JOB ADDRESS 0 ..... ---- - -- ------------- ----------------------------- -------- -- -- ---Ke------------------------------------ <br /> Owner' -------- ----------- - ---------------- <br /> s Name__� ---------- --- hon <br /> Address--------?� �F .�_`."-AZ ----------- -- 0 ----------------­-- <br /> V------- --- - - ------ --- ------------------------------------------------------------------------------------------ <br /> Contractor's Name-----'L------- P-41------------e------------ --------------- ------------------------------------------------ Phone__�d --- <br /> Installation will serve: Residence E] Apartment House.0 Commercial El Trailer t .E]-��M8`fel 0 Other Rlive"yV <br /> -edroom's -------- Number of batl' <br /> units: ._____ Number of 6 size ............ o-- _-_e. .................. <br /> Number of liviri of Sir <br /> Water Supply: Public `system' Commun.ity,.system:.E] Private 0TM,Depth to Water Table ft. <br /> Character of soil to a dipth of 3 feet: Sand E] Gravel E] Sandy Loam' E] Clay Loam E' ] Clay E] Adobe [HardpanC]le <br /> Previous Application Made: (ff yes,date.__.____-_,-_-___) Nb_�ew Construction: Yes e, No E] FHA/VA.. Yes ❑ No 0 <br /> If L <br /> TYPE OF INSTALLATION-AND SPECIFICATIONS: <br /> (No septic. tank-or cesspool permiffed,if.public,sewer is available' within 200 feet.) <br /> i t I 1• W- <br /> Septic.Tank: Distance rom nearesf�well_)'&O--- Di-stance:fror�"foundation___199--- ----Material-P/,IV- ----------------------- -------- <br /> No'. of comoartr�enfs__4_141__� ze-4 ------------Liquid clepth____ ----------Capa_�Ci�-_ 0- <br /> Si <br /> t ? <br /> Disposal Field: Distance from nearest well :__Distance,f rbrin'foundation___-Le----------Distance to nearest lot line -Y-e---- <br /> r <br /> Number f lines'--- ---------------k Len' f each ------------- Width of trench ----------- <br /> 0 Length o .........R-e-1-------- <br /> T P: D. t of -------- <br /> y e of filter material_ p filte"r-maferial-------/__9_� _Total length_________ -------- <br /> + j <br /> Seepage Pit: Distance to nearest well----------- -------!_Qistamce from foundation_----------------Distance to nearest lot line___________-___-_ <br /> l. . <br /> F1 Number 6f pits......1-----!---------Lining material-------- Size: Diameter------------------------Depth--------------------•------------ <br /> Cesspool: Distance:from nearest-W611—-------------D.isfance from found.afion----- ------------,Liping material.-._-________________________________. <br /> ❑ <br /> aterial------------------------------------- <br /> El Size: Diameter._s---11�il---------------- 411-epfh------------------- <br /> ---------------------------------Liquid Capacity-------_----------------­gals. <br /> Privy: Distance from nearest w,ell-,___/_yr------------------- -------Distance from nearest building.____.._______________________..________- <br /> Distance to lot'line------------------------------------------------------ <br /> El -----------•--•-- .....--'--------••----------------------------- ------------------ -- <br /> 4+ <br /> Remodeling and/or repairing (describe):-------------=-----=--''` -----------------r---------------------------------------I-------------------------------------------------------- <br /> ---------------------------------------------------------------------------­-------------- -------------.�7----------- ------------------------- ------------------------------:------------------------------ <br /> -------------------------------------------------------------------------------- =-_-----------...... <br /> ----------------------------------------------------------------------------------------------------- <br /> ------------------------ -- <br /> - ---- ------------------------------------------------ --------------------------- ----------------------------------------------------------------------- <br /> I hereb/certi that I haveprepared f hii'application and thatthe work will'be done in accordance with San Joaquin County <br /> ordinances State .aws,,and-4les and ir�gul 'hon-is of-the San Joaquin Local Health District. <br /> ---------------------------- ------ <br /> . ..Location <br /> ---- ------- - ---- --------- --- ---- --C&- ------ wner and/or Contractor <br /> (Signed)----- ---- -- -- -- --- ) <br /> --------------(Title)'- .. .. ...r---------- -- -- -- --------- <br /> - - ---- -- --- - - ------------- ------------ <br /> By:------------------- <br /> (Plot plan, showing size of of system in, ation to wells, buildings, etc., can be placed on reverse side). <br /> County <br /> f a <br /> %?J_�,YA <br /> 4- 1 <br /> -A— FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED'BY__ ------ ---------------------------------------------- DATE___.9e--—---- ---—--- ----------- <br /> REVIEWEDBY------------------------------------ -- --- 6--A- ---------- i------------------------------------ --------------- DATE---------------------------------------------------------- <br /> BUILDING PERMIT ISSUED-;--------------- ------ -------- ---------------------------- <br /> ---- .--------------- DATE------------------------------------------------------------- <br /> Alterationsand/or -------7=------------------—------------------------------------- --------------------------------------------- <br /> -------------------------------------------- - ----•-•---•------------ ---------------------- --------------------------------------------------------------------------------------------m------------------------------------ <br /> ---------- ------------------------------------------------------------------------------------------------------------ ---------------------------------------------------------------------------------------------- <br /> ------------------------------------------ - ----------------------------- - - ------------------------------------------------------------------------------------------------------------------------------------------------ <br /> ----------------------------------------------------------------------------- I........ -------- ----------------4------------------------------------------------------------ ----------------------------- <br /> -A' - 07, ­­ I? ----------------------- <br /> ----------- <br /> FINAL INSPECTION By:--,--- <br /> iAIN JOAQUIN LOCAL HEALTH DISTRICT <br /> 730 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> EG.9 REVISED 11.59 F.P.00. 2M 6-60 <br />