Laserfiche WebLink
FOR OFFICE USE: <br /> - <br /> -------------------------------------------------------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. .1.1t� ._af <br /> ------------------------- -- -------- ---- (Complete in Duplicate) <br /> This Permit Expires 1 Year From Date Issued �+ Date Issued --------- <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'LOCATIONV_,?j9 --'--v - --.��- ���z•- --- _-:- -- _ ,. ----------------------------------------- <br /> Owner's Name ...' aF'? r - <br /> � ,` ---- ------------------- - --------------------------------- Phone_ ---------•--------------•-•• <br /> a <br /> Address......... - ---------------------- w ~ °1. �r <br /> Contractor's Name-----f- _A�w------------------- -*Z / ------- �� Phone----------------------------------- <br /> Installation will serve: Residencet Apartment House E] Commercial E] Trailer Court [� Motel ❑ Other E] <br /> Number of living units: /_____ Number of bedrooms _1___ Number of'baths !_____ Lot size ---------------------------------- <br /> Water. <br /> .___-__---_____________________Water Supply: Public system ❑ Community,system ❑ Private ® Depth to Water Table ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay LoarTi ® Clay ❑ Adobe❑ Hardpan. ] <br /> Previous Application Made: (If yes,date---------_._ -------) No m New Construction: Yes R] No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE-OF INSTALLATION AND-SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) G <br /> _ <br /> Septic Tank: Distance from nearest well,-o:----.---Distance from foundation--- .0-----------Material__.kn�------------------ <br /> ------- w <br /> AGIR <br /> No.'of compartments----o�----------------Size.yttr!t_7--------Liquid depth----Y-------.-----------Capacityj,2-_A --------- <br /> Disposal Field: Distance from nearest well47o ___.Distance from-foundation-/.19 .__Distance to nearest lot line___.---_____ <br /> Number of lines_ __c------------------- ----.Length of each line----- of trench_.;-V-�-----------------.------ <br /> tiv Type of filter ma'teri -.__Depth of filter material__-/.Q_______________Total^length__,�QV---------­-------------------- <br /> Seepage <br /> -_____.._________-________-- <br /> See a e Pit: Di t <br /> p g stance to nearest well-/ _`____._.___Distancefr__om��++foundation__- ---------Distance to nearest lot line��________ t <br /> Number of pitsA;---------------Lining materia,/2& .._....__.Size: Diameter_.___33------.__-Depth-.'�._ ---------- <br /> Z---_____-_____ G <br /> � <br /> Cesspool : Distance from-nearest well__________ _ <br /> .__-._Distance from foundation__ ._______________Lining material------------------------------------- <br /> C/� I <br /> ❑ Size: Diameter---------------------------- --- Depth-------------------------------------- - ----Liquid Capacity- --------------------------gals. <br /> Privy: _ Distance-from nearest wO--------------------------------------------------Distance from,nearest building_________-.-------.__________..__..____--. <br /> ❑ Distance to nearest lot line----------------- ---- ----- ------------------ -----------------------•--------------------------------------------------------------------- <br /> t <br /> Remodeling and/or repairing (describe):________---__:____-______ ___........._ _ - <br /> V <br /> -- <br /> -------------------- -------- ------------------------ --------------.---- -- ---------------------------------- -------------------------------------------- ---------------------•-------------- -------------- <br /> - i <br /> ------------------------------------- -------- = <br /> ---------------- -----------------------------------------------------------------------•---------....-------------•---------------•--------•------------------------------- <br /> ! i - <br /> -----------------------------------= -------•----------------------•:----------------------•------------•-------------------------------------------------------------------------------------------------------- ------ <br /> 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Coun+y ' <br /> ordinances, State. laws, and rules and. regulations of the San Joaquin Local Health .District. .� <br /> L ; U } <br /> (Si ned <br /> 9 ) 4 - ------------------ -- - --(Owner and/or Contractor) <br /> 8Y: =--------------- - - _ --= ----- - °: ------ = -------- <br /> (Plot plan, showing size of lot, location of system in relation to wells,.buildings,.etc.; can be placed an reverse.side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY/.-04n4414 ----------------------- -- ---------------------------------------- DATE--- 4 <br /> REVIEWED BY------------------- <br /> --------------------- ---------- ------------------------------------------ -_-------------------------- DATE----------------------------------- <br /> BUILDING PERMIT ISSUED------------------ --------------`------------------------- DATE <br /> - ; <br /> Alterations and/or recommends+ions:_ - -------------------•----------------•---------------• •--- ----------•-----------•---------------•-'------ <br /> ----------------------------- <br /> FINAL INSPECTION wBY:-.-/, -:.-- - ------ Datel <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1401 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,Californla Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 9-S9 3M 3-'63 F.P.0 C. <br />