Laserfiche WebLink
Metadata
Document management portal powered by Laserfiche WebLink 9 © 1998-2015 Laserfiche. All rights reserved.
PERMIT <br /> Permit No. <br /> APPLICATION FOR SANITATION <br /> (Complete in Duplicate) Date Issued ----- -* <br /> il <br /> Applica;ion is hereby made to the San Joaquin Local Health District fora p r i, aninstall the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> 2 <br /> 1_0---------- 1 1 a --------- <br /> JOB ADDRESS AN 'LOCATION —-------------- <br /> J <br /> —----------- -- - ----------- <br /> t - Phone <br /> Owne'r's ------------------------ - --------------------------------------------- Ph ----- -- <br /> --------------------------------------------------------------------------- <br /> Address--------------------------(0- -------- ek-at------!��-------­--------- Phone.wv_.4:��Vgpl'7 <br /> Contractor's Name__. --------•------ ----------7�_�_ --------------------------------------------------- <br /> Installation will serve: Residence & Apartment House [] Commercial [] Trailer Court [] Motel [I Other El <br /> Number of living units- I--- Number of bedrooms3--- Number of baths --tli-e0t size -___--7--7----- <br /> Wafer Supply: Public-Sys.tern �Cmmunity system 0 Private E] Depth to Wafer Table _,4kft.­ <br /> Character of soil to a deipfh of'3 feet: Sand El Gravel El Sandy Loam 0 Clay Loam E] Clay El Adobe E] Hardpan F] <br /> Previous Application Made: Yes F1 No ❑ New Construction: Yes ❑ No 0 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS-" k <br /> (No septic tank-or cesspool permiff.ed if public sewer is available within 200 feet.) <br /> T nk: Distance from nearest weil---------- ------Distance from foundation_____.---------------Material------------------------------------------------- <br /> 6 o. <br /> tic <br /> ------- --------------- ---------- ------------------------ <br /> Nof c�`mparfments------------- -- <br /> ------ -----Size--------------------- <br /> 5 Liquid depth Capacity 1 1 ' '_ undaf ion---------------------Distance to nearest lot line____________.____ <br /> 1071�,S,a I ield- Distance from nearest well:, -------Distance from f�' <br /> Nu7mber oi'lines-----------------------------------Length of each line---------------------- -------Width of trench---- '---------- ------ -------- <br /> Type of filter material-------------------------Depth of filter material------------------------Total length_ --------------------------------- 4 <br /> ----------Distance fro foundafion.2�_--------Dist' nce to nearest lot line_________." <br /> Seepage Distanceto'nea <br /> >P�* '_�I---------------Lining maferialj��__.Size: Diameter-3-31"!--- ----Depth---�2_4 7------------------- <br /> E!r Numbe�r of pits- "_1--- --------- X <br /> Cesspool: D;;fance from nearest well-----------------Disfanc'e-from foundation--------------------Lining material__.__.____--___.___------------- ---- <br /> aterial-------------------------------- ---- r's <br /> 7 1 1! ------------- --------Liquid Capacity---------------------------g als. <br /> Size! Diameter_--i------------------------ -- ----Depth-r:--------------------------- <br /> I i I Distance from nearest building------------------------------------------ <br /> Privy: Distance from nearest well------------------------------------------------- <br /> Distance to nearest lot line---------- -------------------------­---------------------------------------:------------------------------------------------- ---- <br /> ❑ <br /> ------------------------------------------------------------------- <br /> jV.__ <br /> Remodeling and/or 4pairing (describe):,"__ ---- ------ <br /> rf 'y <br /> -------------------------- - ---------------------------- m__________------------- -------------- <br /> ------------- <br /> -----------------------I-------------- <br /> - ------ -------- <br /> --------------------------- -------------------------- --------------------------------------------------------------------------------- <br /> ---------------------------------------------------------------------------------------------------------- <br /> k --------------------------------------------------- ----------------------------------------------_---------------- <br /> ------------------------------------------------m------------------ ----------------------------on_and that a+ the work will be done in accordance with San Joaquin County <br /> I hereby erti at I have pre this akplication <br /> ordinances. S and rules a regulatio -s of the San Joaquin Local Health District. <br /> C6ntractor) <br /> . .......... ... <br /> (Signed)------------- ------------------------------------ -------------------------- ­ff-------------r---------------------------------------------- <br /> ------------------- <br /> ---- ----- -- ------------------- <br /> By:---------------------- ----------------------------- <br /> (Plot plan, showing size of lot, location of system in re ion to wells, 6Adings, etc., can be pi Lion reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY----------- ------ ..... ..... ........................... ------------------------------ DATE--------_ ----------------------------------------------- <br /> - ------------------ <br /> R- EVIEWED BY---------------= ----------- <br /> ------- - ---------------------------------------_-------- <br /> ----------------------------------------------------------------------D----A---T--E <br /> BUILDING PERMIT ISSUED..'---------- ---- — DAT _--_-_-- -N-I,----�----P---.--.---- <br /> --.--.--.--.-14-- <br /> ----------------Z--Z------ <br /> Alterations and/or recomnendafions:------------------ - ------ <br /> - ----------------- --------- ------------------------------- <br /> ---------­---------- ----------------- -------------------- > ------------------------------------------------------------------------_------------------------------------ <br /> - <br /> - <br /> - <br /> - <br /> ----------------------------- ----------------- - - -------------------- <br /> _1------ <br /> ---------------- <br /> _1------ <br /> ---------------------------------------------------------------------------- <br /> ------------------------------------------------------- <br /> -------------------- ---------------- -------------------------------------- <br /> ------------------------------------------------------------ <br /> FINAL INSPECTION -BY:---- - <br /> ------- ................. eDt0- --- ---- ---------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> I <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street $14 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M Revised W-2100 <br />