Laserfiche WebLink
77 r <br /> APPLICATION FOR SANITATION PERMIT Permit No. .. -------- <br /> [Complete in Duplicate) 6f/ <br /> Date Issued <br /> Aplicalion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This <br /> 6 With Count Ordinance No. 549. . -3, <br /> application is made in compliance 4-1 <br /> 0 Count <br /> W <br /> —4 0C .. ---------- <br /> JOB ADDRESS AN ATION- ---- - ---- - ...01___.4M_4fW---- <br /> V <br /> Name--------UA�X*s------------ -----r-P------------------ ----------- --------- --------------------- --------- -------- Phone------------------------------------ <br /> Owner's <br /> cam <br /> Address----------------------- ---------------- ------------------------------------------------------------- <br /> Contractor's Nam_g- E---------------- ------------------------------------------------__------------ Phone_]✓� <br /> Installation will serve: Residence Apartment House 0 Commercial E] Trailer Court E] Motel ❑ Other ❑ <br /> Number of living units: -1---- Number of bedrooms 3--- Number of baths Lot size -------------------------- <br /> Water Supply: Public system El Community system El Private 0 Depth to Wafer Table-AS-ft. <br /> Character of soil to a depth of 3 feet: Sand [] Gravel [3 Sandy Loam [] Clay Loam E] Clay E] Aclobek Hardpan []. <br /> Previous Application Made: Yes E] No g New Construction: Yes N No 0 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet <br /> Septic Tank: Distance from nearest well--SS- --------Distance from foundation----Y------------Material-- ---------------------- --- ----------- <br /> No. of compartmeirfs-11-1--'.--------------Size6Z:361&_--:_-_Liquicl -Capacity <br /> Disposal Field: Distance from nearest .......Distance from foundatipn--/o..........Distance to nearest lot <br /> Number of lines----9=rl-A— ------Length of each line--SO'__J/ Width of french,___;Z_54.�------------------ <br /> Type of filter material /7- 1"Y<-Depth of filter material---- --------Total length......FO............................. <br /> -- -------------------- <br /> r <br /> Seepage Pit: Distance to nearest well"", __.___.Distance om foundafion--r.-Z-47__--- Distance to nearest lot ------ <br /> Ir <br /> Number of pits.6_1-_,_P--- --------Lining material-------- ---------- - Size: Diameter--e-3 ri___Depfh__.Z0--------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation - -----------------Lining material___-.-____-----------_--.-____-_-____. <br /> ❑ <br /> aterial------------------------------------- <br /> El Size: Diameter------ -------------------------------Depth------------------------------ --1 ------Liquid Capacity- -------------------------gals. <br /> Privy: Distance from nearest well------------------ ---------------- -- ----------Distance from nearest building__-__-_____..______._______----.-__---._ <br /> �] Distance <br /> uilding---------------------------------------- <br /> Distanceto nearest lot line-------- ---- ------------------------------ ------------------------------------------------------------------------------------------------ <br /> Remodeling and/or repairing (describe): ----- - --------•---------•-- <br /> ----------------­­- ------------------------------------------------------------------ <br /> 1�r--- ------------ <br /> -----------------------­------------------------------------------- ------- -- ---------------------------------------- ----------------------------- ------------------------- <br /> ------------------------- ------------------------------------------------------------------ ----------------------------------------------------------------------------------_------------------------------------------- <br /> ------------------------ ---------------------- --------------------- ------- --------------­-----------------------------------------­- ----- <br /> ---------- - -- - -- -- ------ - ------- -- <br /> I hereby certify that-01have pr pared this application and that the work will be done in accordance with <br /> ordinances, State laws,(/an rul and re/gullatt, ns of the San quin Local Health District. <br /> S <br /> F <br /> [Signed] <br /> ....... . -(Owner and/or Contractor) <br /> - -------------- <br /> ......... . ------- r------------------- <br /> ------------- ---- ------- ...... ------- ----- -- -- ---------1:------ <br /> ....... <br /> --- -- ---- - --- ------------ -- as-. etc c----(Title <br /> (Plot plan. showing size 'o' location of system in tela on Zo:wells, buildings, etc., can be p1donreverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY. - -- -- -------- ------ -- --- - -------------- ------------------------------------------- DATE_._�Z --- --------------------------------- <br /> REVIEWEDBY------------------------------- ------------------------------------------------------------- --- ------------ DATE_ -------------- <br /> BUILDING PERMIT ISSUED---------------------0...... ----------- ----------------------------------------------- DATE-------------- <br /> ------ <br /> Alterationsand/or recommendations:-------------- ---------------- - -------------------------------- --------------------------------------------------------------------------------------------- <br /> ----------------------------------------------­------------------- ------------­­---------------------------------------------- ---------------------------------------------------------------.................... <br /> -------------------------------------------------------- - ---------------------------------- ------------- ------------------------------------------------------------------I--------------------------------------- <br /> ------------------------------- ------------------------------------------------------------------ ------------------------------ ----- -----------------------------------------------­---------•---------------- <br /> ----------•--------------------------------- - -------------------- - ----------------------------- ­­ --- <br /> ---------------------------------------- -------------------------------------------------- <br /> --- - --------- I- <br /> / . - ), -�-_,� <br /> Z <br /> FINAL INSPECTION BY:.-- ----- --- -------------------- Date------------------------ <br /> --------­------ ------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 Soufh American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M 145446 ATWOOD 12.54 <br />