Laserfiche WebLink
OR OFFICE USE: <br /> --_ �/_ _ _�- ---------------------,[ ---� APPLICATION FOR SANITATION PERMIT Permit No. .__l_.1_S" _�� <br /> ------------------------------------------------------ -- {Complete in Duplicate} 61 <br /> ............___________________________________.___.__ This Permit Expires 1 Year From Date Issued <br /> Date Issued _______ �_.-T <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--------- Y3,5---- -- ----------------------------------- ------------------------------------------ <br /> Owner's Name___._____ - T Phone-( <br /> 7 S4 9o -------- <br /> Address--- <br /> ______Address------------------------------------ `' - ------------------------------------- <br /> ` ------- --------- <br /> Contractor's Name--------- ,[ ------ 4---*----------------------- ------------------ ---------- Phone ?_450'7----- <br /> Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __/---- Number of bedrooms _ ___ Number of baths __ -_ Lot size __13__ .l-`r_s�__'_---------------------- <br /> Water Supply: Public system .X Community system ❑ Private ❑ Depth to Water Table <.._�____ ft. <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 X New Construction: Yes ❑ No�' FHA/VA: Yes ❑ No V1 I <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> {No septic tank or cesspool permitted if public sewer is available within 200 feet.} 4 <br /> Septic Tank: Distance from nearest well_______________Distance from foundation--------------------Material ___.___.__-________._____.____.._.___.___-. <br /> ❑ No. of compartments-- --------------- -------Size--------------------------------Liquid depth----------------- -------.Capacity----------------------- <br /> Disposal Fiel Distance from nearest wellDistance from foundation-----r`2,E---------Distance to nearest lot line---A4!_____ <br /> Number of lines-----------/---------------------Length of each line----------/Q'__._------.Width of trench.------ -------------- <br /> Type of filter maferial�',,oeo4tf4__Depth of filter material-----/-,'r .......Total length-------------------------f©_r_•____ <br /> Seepage Pit: Distance to nearest well�____Distance from foundafion__ZQ/--------Distance to nearest lot line__ Q�_____ -.001�a Number of pifs.-..-/-------------- materiaSize; Diameter_--__- Depth--------- ............. S <br /> Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lini g material________._______________.______-___-_. W <br /> ❑ Size. Diameter--------------------------------------Depth-.-------------------------------------------------Liquid Capacity- --------------------------gals. <br /> Privy: Distance from nearest well-------------.-----------------------------------Distance from nearest building-- �-----_-----__,__-_____-_____.__.____. <br /> ElDistance to nearest lot line--------- ----------------------------------------------------------------------------------------------------------------------------- <br /> -- , <br /> Remodeling and/or repairing [describe]:_______. <br /> ----------------------------------------------------------•-••------•----------------------------------------•------ ---------------------------------------------------------------------•--------------------------------- Y <br /> --------------•------------------------------------------------------•---------------•---------------------•----------------•----------------------------------------------------------•-------------------- - -------- <br /> --------------------------------------------•--------------------------------- ----------------------- --------•------------------------------------------------------------•--------------------------------------- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County r <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed) --------------- -- `-' (0 er and/or Contractor) <br /> ------ <br /> By:....-- _ ------------------------ ----•--------{Title} F <br /> (Plot plan, showing size of lot, location of syst m in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ------------- r ^ -------------------------------- DATE-------4Z ----------------------- <br /> REVIEWED BY--------------------------------------------- ---------------------- ------------------------------------------------ DATE-------------------------------------- <br /> --- ---------------- <br /> BIJILDING PERMIT ISSUED --------- �_. <br /> .�� — DATE:Alterations and/or recommendations:_-____ _ -_._�. ____ � __., <br /> - - ------- ------- - --------------------------------------------------------------------------------------- -•--------------------------------------------------- <br /> ------------------------------ -------- ------------•-------------------------------------------------------------------------------- --------•­------------------------------------------------------------------------ <br /> FINAL INSPECTION BY:...... .... -- ----Gly -------------- Date-------- /�- -- ..�f----.---- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> E5 9 REVISED 6-59 3M 3-'63 F.P.120. <br />