Laserfiche WebLink
FOR OFFICE USE: <br /> 9;- <br /> ---------------------- Permit No/, <br />------------- -------- APPLICATION FOR SANITATION,.PERMlT ---------­ <br /> 47�------- ------------------------------------- <br /> 4,-. - ----------------------------- Date-Issued---------------------- <br /> ---------- (complete In DuRlic�te) <br /> This Permit Expires I Year From Date Issued <br /> Application is hereby made to the Sb'n Joaquin Local Health District for a permit to construct and install the work herein descrUid. <br /> This application is made in complianci with County Ordinance No.`549- <br /> 4 :::- - 1<!. N..- <br /> C71— "� <br /> " a 0 2 <br /> ------- ------------ ........ <br /> ­--................................ <br /> L!,OC N..... ----------- -------------- <br /> JOB ADDRESS AND Ailb <br /> Phone------------------------------------ <br /> ------------ ---------------- -------------------------- <br /> Owner's Name--- -4;1,. <br /> 7 ........... _------•-•-------••-------------- <br /> Address............................................................ .................................. -------------*---------------------------* <br /> .1 . I I I - ' Phone----------------------------------- <br /> Contractor's Nam4._'-_!':­ — .1 '. __ _.!:�.......................................... <br /> -­------------------------------------------- <br /> ------------- <br /> . Commercial [j Trailer Court 0 Motel [3 Other <br /> Installaflon,wiii serve: Residerice 0, Apartment.House ED Co <br /> A . ------------------------ <br /> ❑ <br /> _n ts: --------Number of bedro6 ger of baths -------- Lot size -------------------•------•----•••-- <br /> Number of liven units: :__.u' i: ms -------- Num <br /> _Pr_iv�t;,❑ -Deofh�-t,;Water T�bl�­..i--- ft. <br /> Water Supply: Public.,,syst�ii� <br /> f4 <br /> Character of soil to a depth of 3 feet: i Sand E] Gravel 0 Sandy Loam,[] Clay Loam (I <br /> Clay [3 Adobe❑ Hardpan [1 <br /> tc�e-------_____________l No El New Construction: Yes E] No.[3 FHA/VA. Yes Ej No 0 <br /> Previous Application Made: (if yes, <br /> TYPE OF-INSTALLATION AND SPECIFICATIONS. <br /> (No se tic tank'or cesspool permitted if public sewer is available within iOO feet.) <br /> Distance from nearest _'�Distanc n-._________________Material--_____-_____-..____....___..............._...... <br /> Septic Tank:-- Dista i e from founclatio <br /> ----------------------- <br /> of 4 compartr�enf s----_------------_-- .......... <br /> 'El o" ._._.SizeLiquid depth---------n -----------Capacity <br /> foundation-___._.___.....:....Mitance to nearest lot line....._..-._.__... <br /> Dispos�al Field:- -Distance'from nearest well________________------ j <br /> e ----------�Distance from foundation <br /> -----Width of trench----------------------------------- <br /> mber,of,lines'-----------­-----------------------Length of each line------;_.-----.;--------- - <br /> El Nu. <br /> filter. "ter ------------------------Depth of filter material________.___________.-Total length------------------------------------------ <br /> Typ r.ma ia <br /> '9'of fil <br /> Seepa'9e Pit: Distance to-nearest well----------------------Distance from foundation--------------------Distance to nearest lot line.. <br /> , k <br /> U. <br /> N'rnber of'pitsJ---------------- ---Lining.material------------:-----------Size. Diameter-J--;.......... --------Depth-------------------------------- <br /> Cesspool: Distance from nearest well______________•_Distance from foundation--------------.___.L.ining material_-_________-_____"-______-_,___-"--- <br /> ------gals. <br /> ---------------------- <br /> Size: Diameter. ----------Depth-------_--------------------•----------------- .,-Liquid Capacity. <br /> ------------------- <br /> welL----------------------------------------f_-•-:--Distance from nearest building--_------------------------------------ <br /> Privy: -Distance from.h I earest . r- �. 11 , I . . _­----­--­------------------------------- <br /> Distance to neatest lotiline------------------------------------------------ --------------------.--.•-----••- - <br /> Remodeling and/or repairing (des' ----------------------------------- ........ -------------------------------------- <br /> ------------------------ <br /> ............................................... <br /> --------------------- <br /> ------------­---------------------------------------------------------------- --------- -------------- <br /> ................................... y <br /> -------------------------------------- ... ... <br /> -------­---------- ---------------- <br /> ----------------------------------------------...................... <br /> ...............................------------------7--- < -------------------------------------------- <br /> -------------------------------------------------------------­--- <br /> --------------------- ---------__­---------------------- ---k--- ---------------p1-i-cation and that the work will be done in accordance with San Joaquin County <br /> I hereby �ertity 1 that I have pr�pared this application <br /> Ordinances, State laws,'and rules and regulations of the San Joaquin Local Health District. <br /> ------------- -----[Owner and/or Contractor] <br /> ---------- -------------------------------------- <br /> (Signed)-----------------­.......................... ----------- <br /> ------------------­-- <br /> ....................... <br /> ........................ ----------------- <br /> By:.................. ----------r----(Title)----------- ---------------------------------- ---------------"_- <br /> (Plot plan,'showing.size'of lot,.location of system inrelation to wells, guildings, etc., can be pla�ced on reverse side). <br /> FOR DEPARTMENT USE.ONLY ­ <br /> 01 <br /> APPLICATION ACCEPTED BYI-1-1--------------------------------------------------- ------ ------------.............. ---------- DATE--' <br /> Z-------------------------------------------------- <br /> --------- DATE' --------------------------------------------*----------- <br /> REVIEWEDBY-------------------- ------- -------------------------------I----------------------------------------- I <br /> ; 1-1.. DATE---------..................i� <br /> --------------- --------------- <br /> BUILDING P-ER,MIT-ISSUED��--�----=��:7�-7-1�-�---------------------- <br /> Alteratioris and/vir recoj�mendatic;_ns_ - .................... <br /> ---- - ----------- <br /> - -------------­---- ........... <br /> - ------------- -------------- <br /> ............. ....... -------------- -- <br /> ------------- 0, <br /> - ------------ -------------­-------------- <br /> ................---------- --_---------- <br /> ------------- <br /> .............. ---- <br /> --------------- <br /> -------------- ---------- <br /> :�--------------------------------- <br /> --- . ........... ---------------................ <br /> BY: Date------- ---------- ---------- . <br /> - <br /> FINAL INSPECTION - ----------------------------------------- <br /> ---------------- <br /> SAN JOAQUIN LOCAL-HEALTH DISTRICT <br /> 130 South American street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Manteca,.Callfuzrila Tracy,California <br /> Stockton,California Lodi,California <br /> Es 9 FiEVIRED B-59 2M 5-61 ATLASIS—, 2'. <br />