Laserfiche WebLink
4� APPLICATION FOR SANITATION PERMIT Permit No. -------- <br /> (Complete in Duplicate) 9 <br /> to <br /> • Date Issued - <br /> -------------------- <br /> Applica-�ion 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 /> t e <br /> '� • � <br /> JOB ADDRESS AND LOC-yA�,T�ION..r '; '-----=--- �' - ------------------------------ --------- <br /> ,AAIN/ <br /> ' 4l i,. ,- 11 ?� } -- ---- <br /> ------------- <br /> -~ Phone- <br /> ----------- <br /> Owner's Na11meQe---- <br /> Address.- J�J �. r:�i!.-� l..-•---- - --- ----------------------- -•-------•--- ----------------..-..---------••- <br /> ` 1 <br /> Contracts 's �_h 7. �,h „�=- .�2 ------------- --• ._ Phone <br /> r Name .._- . <br /> t <br /> Installation will serve: Residence vA artment House ❑ er�ial ❑ Trailer Court ❑ -Motej ❑ Other P❑ <br /> � p ryry <br /> Number of living units. _4--- Number of bedrooms( Numbe! fbat s"._ _Apt Lot.size _� "'}� �a' <br /> Water Supply. Public system '❑"'Community system ❑"`Private V Depth to Water Table ft.'— <br /> Character of soil to a depth of 3 feet: '.Sand ❑ Gravel ❑ Sandy Loam ❑ Clay:Loam ❑. Clay ❑ Adobe Er"'Hardpan ❑ <br />'i Previous Application Made:- Yes:El No ❑ New Construction: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank'or cesspool permitted if pub lic�Isewer is available within 200 feet.) x <br /> Septic 'A: Distance from nearest well- -----.-_.bistance from foundation__-- _ ._...--.Material___._' r s"" - 1 I- - <br /> [, No, of compartments_- ' " } -_.Sze � �---- Liquid,depth-- -_ --.,Capacity----- ' <br /> sem' <br /> Disposal'Field: Distance from nearest well---..--: istance from fouAda tion-14J !r""_bistaAce to nearest lot line.. <br /> �' f <br /> Number of lines-------------- - _---- -Length of each line____-- -.5 -_- Width of trench..._._.__-_- --_--- <br /> , <br /> 'If3e Depth of filter material-_--_�- ._-- ---Total length.......... <br /> Type of filter_material.. Q E p ) <br /> i /•��F 1 - � <br /> r <br /> Seepa e Pit:_ Distance to nearest well'- 0-"t �'�Distanc fro oundation_-..___ " Distance to.nearest lot line--`-------------- <br /> �g Size: Diameter -d�E,r------Depth___�� ----------------- <br /> Number <br /> ----------`-. <br /> Number of p;ts--------7---------;Lining material----=------------- <br /> I it w 1! 1 .� r� <br /> Cesspool: : Distance from nearest well .------_:Distance from,found&tion;,_--_----�"�`'Eining Material-------------------------------------- <br /> S e: <br /> --------------_.___--_-__:__-----Sixe: Diameter------ -i----------------- ----------I Depth------------------------ L x ._ -:._Liquid Capacity-.-----=-. -•--------------gals. <br /> Privy: -Distance from nearest well-------------------------------------------------Distance from nearest build ing__A-_,:-_,�__:____---------_---------. <br /> ❑ ------------------------------------------- <br /> f« �'Dis#ante to nearest loft'line--------- ----------------------- ------------•-------�--------=-------------- ----- - •---------- <br /> I Remodeling and/or repairing (describe):------------------ -- It -------- <br /> --------------••-------------------------...-----.---------•-=-----------••--------------------------•------------....------------------------------ - -------- --------•---•-•--------------------------------------- <br /> ... I; ' -I,-� t - L4 i i <br /> --------------------------- --------- ------------------•-•-•-----------------•------------.-:-...--------------------------------------------•----•---•-------------------------------------------------------- <br /> i, f #. <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 Tegulations �ofhe <br /> ! <br /> ? � S..a--n-- Joaquin Local Health District. <br /> :-----------Owner and/or ContractorSi ned By:------------ <br /> - -------------------------------4­­-------- - ------------------------ ­--------------------------------------==---- _._[rile)= �------------=.......... ... <br /> (Plot plan, showing size'of.lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> -., FOR DEPARTMENT USE ONLY ' <br /> • r ... F. <br /> APPLICATION ACCEPTED BYE-------------------- DAT ---------.------------{------------------------------ <br /> } <br /> REVIEWEDBY------- ------ -----.��--'- -f-- ----- - - ------------------------------- --------------------------------- DATE-co'A----------------------=---=----------=---------------- <br /> BUILDINGPERMIT ISSUED------.....- ---------------- ------------------------•----------------------------------------- DATE_ ..-•- '-..------�:------------ <br /> Altrations and/or recommendations: ------ ---.•..__...._- ----------------------------------------------------•---------- <br /> ++ .�: �- 7r�.f-------------------------== ' `� •--- -----------------• ----------------------- <br /> --------- - ----- --------------- ------- <br /> ----------------- <br /> Y M <br /> --- ------------------------------------------------- --- <br /> ----------------------- <br /> FINAL INSPECTION BY----- ------- ------•----------------------- ..--- `Date =" •-=-----.-._.----------- ---•-----------------------------••--- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 110 South American Street 30D West Oak Street 132 Sycamore Street 1 914 North "C" Street <br /> Stockton,.California UAL California -Manteco, California Tracy, California <br /> E <br /> ES-9-2M 145446 ATWOOO 12-54 <br /> t* \Fr <br />