Laserfiche WebLink
' - -------- <br /> APPLICATION FOR SANITATION PERMIT Permif,No. <br /> Complete in Duplicate) -Date lssue&__� --- ---- <br /> Alicationlherbby made to the San Joaquin Local Health District for a permit to construreand install the Work hereindescribed. <br /> i <br /> Thppis-application is made in C'orhPlia6ce with County 'Orclii.ianc: No), S49, <br /> ------------- ------ --- <br /> JOB ADDRESS AND LOC-ATION­(f_ ----—------------- <br /> I/ Phone--- ----- <br /> '17 Al, ----------- <br /> Owner's Name ------- - <br /> ---­--------­----------------------------------------------------------------- <br /> Address-------------- --------------_--- --------------- <br /> -------------- <br /> Contractor Name________________ <br /> Phone-- <br /> CoI---------- <br /> Installation will serve: Residence Apartment Hous6 [I Commercial E] Trailer Court El Motel [I Other 0 <br /> Number of living units: Number bedrooms -2. Number of baths __/---- Lot size -07' -------- <br /> Comm-it system E] Private E) D��pth to Water Table _�ft. <br /> Water Supply: Public-system>V un y <br /> Sandy Loam El Clay Loam El Clay El—Adob Hardpan <br /> Character of soil to a d of 3jeei:2 Sand F� Gravel 171 <br /> Previous Application Made- Yes 0 -NoX New Construction: Yes E] N 0� <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: 00 feet.) <br /> (No septic tank or cesspool Permitted if public sewer is available within 2 <br /> V 7 <br /> Septic Tank: Distance from nearest well________________'Distance--------- from. rDistance ffoundation--------------------Material---------L----------- ------------------------- <br /> - id depth---- --------------------Capacity----------------------- <br /> -------------------------------Liqui ------ <br /> No—of,compartments-------------- --------­Size to nearest lot line____._____._.___. <br /> Disposal Distance from nearest well------------------Distance from foundation---------------------Distance <br /> Width of french--------------------------------- <br /> - ----------Length of each line------- <br /> Number of lines—,-------------- ------- <br /> F filter ma -----------------Dept o r rn Total length------------------------------------------ <br /> P_�71. Type of terial--------- h-' 'f'filfe material---------------- T i n e <br /> 'A , f m fzuoafion---144 ----Distance.to nearest lot I <br /> Distance to nearest well-- Distance �p ----- <br /> --- - --------- Di 4 Depth____-_ ,;:r-------- <br /> Num_ <br /> Pit: Di umber of pits-_�-__ ---Lining material S_ Diameter- <br /> K, - i __/ <br /> Cesspool: Distance from nearest --------------------Lining material------------------------------------- <br /> oil-----------------Distance from foundation <br /> w. <br /> ----------- :,--------------------------gals <br /> ,--------------------------gals- <br /> El size: Diameter---------------------------------------D.epth------------ 7---------------------------Liquid Capacity-- ------------ <br /> ----Distance. from nearest building._`---------- ------------------ <br /> Privy- Distance from nearest well------------------ -------------- <br /> --------------------- ------ ---------------------------------------------- <br /> Distance to nearest lot line__---_:___---- --------------- <br /> 0 <br /> ------------------------------I------------------- <br /> -------------------- ------- <br /> ibel-------- ------------ --- ---- ------'------------------ <br /> Remodeling 'and/or repairing (describe}::------ -- -------------*----- ----------------- <br /> I ---------------------------------------------------------------------------------I------------------------------------ <br /> -------------------------------------------------------­----------------------- ---------------- ---- <br /> 11 _0- ------ ------------------------------------------ ---------------------------- <br /> -- - - --------------------------------------------------------------------- <br /> -------------------------------------I------------------- ------------------------------------------------------ <br /> -------------------------------------------------------- <br /> ------- ------ --- <br /> ---------I hereby- - - . certify­that I have -prepared.-fh-is,application--and_-that the work will be done in accordance with San Joaquin County <br /> ordinances, Sta aws an a ul and regulations of the San Joaquin Local Health District. <br /> Owner and r Conlaclorl <br /> ----/--------- -- --- -------------------- -------------------------------- <br /> (Signed ----- ---- i...... . . . ... . <br /> --------------------(Title)- <br /> - -------- 0 reverse <br /> .4 e etc., can be p a si <br /> By:--------------------------------- de <br /> 4'1 �'i n of !�ystem 14 relation to wells, buildings, <br /> (Plot plan, showing size..o . 0 - t — - <br /> FOR DEPARTMENT USE ONLY <br /> ------------------ ----------•---------------------------. DATE�----------------- -------------------------------- <br /> DATE----!%s----------------------------------------------- <br /> REVIEWED <br /> I------------------------- <br /> ------------------------------------------------ -------------------- <br /> APPLICATION ACCEPTED B)- --------- --- --- <br /> REVIEWEDBY--------------------------------- 2r-- ----------------- ---------------- DATE-----------0- ------------------- ---------------------- <br /> BUILDING PERMIT ISSUED------------------------------------------r------------------------------------------ ---------------------------------------------------------------- <br /> -----=---------------------------------------------------------- <br /> Alterations and/or recommendations---------------------------- -------------------------------I------- <br /> i ----------------------------------------- - ------------------------------------I--------------------------------------------- <br /> ----------------------------------------------I-------- ? ----- <br /> __1--------!-------------------------------------------------- ----------------------------------------------------------- ---­---------------I----------------------------------- <br /> ---------- ----------------------- -------------------------------------------------------------------------- <br /> • <br /> -------------------- ------------------------------------------- <br /> ------------------------------------- -:-------1—--------------I-------------- -1--- --- ---------------------------------------------------I------- ----------------------------- ------------------------------------- <br /> ------------------------- ------- --------------------- - <br /> ----------------------- <br /> Date-, --------------------------------- <br /> FINAL INSPECTION' gy�:-------- AW -- -------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT 814 North "C" Street <br /> 132 Sycamore Street <br /> 130 South American Street 300 West-Oak Street manfeca. California Tracy, California <br /> Stockton, California' Lod;, California <br /> ES-9-2M 10-52 Revised W-2100 <br />