Laserfiche WebLink
OFFICE USE:,e <br /> a <br /> Permit No. .-./ <br /> ---7 <br /> APPLICATION fr% �ANITATION PERMIT- --------- ---------- -------------- Ir S. <br /> - -- ------ ---- ---------------------------- (C plicate) Date Issued <br /> -------------- ........ -- ---------------------- This Permit E;=From Date Issued '2V'rz;3a� <br /> Application is hereby made to the San Joaquin Local Health is cic, or a permit to construct and install the work herein described. <br /> 11applic8tion is made in compliance with County I Is <br /> T u Ordinan e.. <br /> -------------------------------------------------------- <br /> -- <br /> JOB ------------------------------- <br /> ADDRESS ANIP� OC TION----- <br /> irk <br /> - - ---------------------- --- --- -- <br /> ----------------------------- -- - ----- Phone-1 77 <br /> ...... ..77--- <br /> Owner's Name----- - --------------------------- ------ —------ --- --- <br /> --------------------------------------- <br /> - ---- ---- .... .... ---------- -- ------------------------------------------------------ <br /> Address--_---------------- --- ---- <br /> T' <br /> Contractor's Name------------------------- --------- ---------------------------- ........ -------- Phone----------------------------------- <br /> Installation will serve: Residence Dd Apartment House ❑ CO mme'rcIal E] Trailer Court E] Motel 0 Other 0 <br /> Number of living units: -./--- Number of bedrooms J__ Number of baths x2_ Lot size -------------------- <br /> Water Supply. Public system E] Community system El Private 9 Depth to Water Table-3--5-,ft. N <br /> Character of soil to a depth of 3 feet- Sand [] Gravel ❑ Sandy LoamE] Clay Loam [] ClayE] AdobeXr Hardpan C] <br /> Previous Application Made: (If yes,date--------------------) No E] New Construction.: YesE] NoX FHA/VA.. Yes [] NoE] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> *pTp n k Distance from nearest well_________________Distance from foundation--------------------Materiai----------------------------_---------------- <br /> No. of compartments-------------- ----Size------------------------- ------Liquid depth--------------------- ----Capacity------------------------- J <br /> I Id: Distance from nearest well.S_4......Distance from founclafion-1_0...........Distance to nearest lot line----Is---------- <br /> � V X <br /> Number of lines_____________._____ Length of each line------- 570--------------Width of trench.---- 1�--------------------- <br /> Type of filter material--- Depth of filter material---- Total length--------------- ......... ------- <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line-.--_-_-__--___._ <br /> ❑ <br /> ine----------------- <br /> El Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth------------._-_-.--------------- 3 <br /> Cesspool: Distance from nearest weil-----------------Distance from foundation----------------._Lining material_._._______._..__-__._____._____.___ ft <br /> 171 Size: Diameter----------------------------- ------- Depth------------------------------r------ --------------Liquid Capacity--------------------------gals. P <br /> Privy; Distance from nearest well----- -------------------------------------------Distance from nearest bui#cling--------------------------------------_ 0 <br /> F-1 Distance to nearest lot line------------------------------------------------------------------------------------------------------------------------------------------ E <br /> Remodelingand/or repairing (describe):----------------------------------------------------------------------------- --------------------------------------------------------------------------- <br /> -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------- -- <br /> --------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> --------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------- <br /> I <br /> -I her y ce ify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> e <br /> ordinanc here <br /> laws, alted ules and regulations of the San Joaquin Local Health District. <br /> (Signed)---- - - ----- --- -- <br /> --- - --------- - -'0,, <br /> ner and/or Contractor <br /> By:------------------------ ------ --- - -- ---- -- - --------------------------------(Title)--- ---------- <br /> ----- -------- <br /> (Plot plan, showing size of lot, location of system in relafi 0 wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY. <br /> " 14 <br /> APPLICATION ACCEPTED BY--------------------------------------- ----------------------------------y -1------- DATE---------5 3_1---l c -------------- <br /> REVIEWEDBY--------------------- -------------------------------------------------------------------------------------V- 7- ------- DATE------------------------------------------------------------ <br /> BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- <br /> Alterationsand/or recommendations------ ----_ - ---------- ----------------------------------------------------------------------------------------------------------------------------------- <br /> --------------------------------- ----------------------------------------------------------- ------ ------------------------------------------------------------------------------------------------------------------------ <br /> ---------- ---------------------------------------------------------I---I--------­­------------------------------------------------------------- -------------------------------------------------------------------------- <br /> --------------------------------------------------------------------------­­--------I-----------------I----------------------------------------I---------------------------------------------------------------------------- <br /> ------------------------ ------------------------------•-------------------------- ----------------------- ---------------- ----------------------------------------------------------------------------------------- <br /> FINAL INSPECTION BY:.__,;� ------------------------ Date------ --------------------- --------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 8-59 3M 3-'63 F.F,CD. <br />