Laserfiche WebLink
FOR OFFIC//E: <br /> l. (� <br /> __.._✓._._ ____.._'1y APPLICATION FOR SANITATION PERMIT Permit No. ...I k1...�. <br /> (Complete in Duplicate) <br /> Date Issued ..9. .--�:?i <br />----.-------------------------------- --- -- --------------- --- This Permit Expires 1 Year From 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 L �O � l <br /> Owner's Name------... --------------------------------------------------- ......................................... Phone.................................... <br /> Address -----•......--- ..•-•.......................•- <br /> _'... <br /> Contractors Name._._.._._. ---•- Phone................ <br /> Installation will serve: Residence [[Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other <br /> Number of living units: ... Number of bedrooms S. Number of baths/--*-Lot size 4AC4.—A...............................I...... <br /> Water Supply: Public system ❑ Community system Private ❑ Depth To Water Table <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Q'"Hardpan ❑ <br /> Previous Application Made: (If yes,date____________________) No Rr New Construction: Yes PrNo ❑ FHA/VA: Yes gg-'No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank:or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: -'Uistance from nearest wel.....!7=---Distance from-foundation-_---/ ........Material.4�/6 ................. <br /> No. of compartments-.-Y---------- ----Sizaa!f4 44 ` _.'_.... .. k."_ uid de th_.. . .. .Ca acity/tea .. <br /> •-••--. <br /> Disposal Field: Distance from nearest well- --------Distance from foundation....AP........Distance to nearest lot line.`........ 014 <br /> Number of lines-------A----�_____ Length of each.line ./'0 � /J Width of trench..-A.-..-�................... <br /> Type of filter material�, �L _Depth of filter material..fid. ___.....'_Total length.-_- ................... <br /> Seepage Pit: Distance to nearest well _. � _.___-_.Distance f ' ndation___../A4 Distance to nearest lot line... ��.... J <br /> Number of Its g Size: Diameter .............Depth__0_0...------•-------•--••. <br /> ®� p' A------__--_-Linin material.. of.0,i � <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- <br /> El Size: Diameter-------------------------- -----------Depth.----------------------------------------------------Liquid Capacity............................gals. <br /> Privy: Distance from nearest well-_--___-_-____---------------------__-------Distance from nearest building.......................................... <br /> Cl Distance to nearest lot line------------ -------------------- ---•--- ---....................................................................... <br /> Remodeling and/or repairing (describe): - an -••-•-----•----••----•---------•------•---•-----.. <br /> --------•---•-----•--------•----•-----------------•-----------•----------------------------------------------------------•-------../......--•-----•-----•-•---------- ...................................................... <br /> -----•-------------•-•--....----•-•-----...---•------------•-•••----------•---------------------------•----••-•••••---------------------•------••--•--••----•----••----••-----•-•••---•-•-••--...---•-•-----------•------... <br /> ------------------------------------------------------------•----------------------------------------------------------------------•-----------------•--------.------------------------•----•------------------------•------- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances. State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)---•••--••----_1a....-- - --------- - --------- - (Ow dor Contractor) <br /> By:--•-----•--------------------------------•••-- ------... . .--- `' (r+le) ------------ ------------ <br /> (Plot plan. showing size of lot, location o stem in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---- ------------------------ DATE........ -.._------------------ <br /> REVIEWEDBY................................. --------------------------------------------------------------- .......................... DATE--------.................................................. <br /> BUILDING PERMIT ISSUED------ •-----•--------•---- - DATE------------ <br /> -- -- .......................... <br /> Alterations and/or recommendations:-__/_ <br /> -------------------------------------------------------------------------------------------------------------........................................................................................................•-•••-- <br /> ---------------------------------------------------------------------•------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> -----------------------•------- ---•------- --------------------------------------------------------------------------------------------------------------------------------------------- ----. ------- ............... <br /> 0 <br /> FINAL INSPECTION BY:. -4 -- Date....... <br /> ------ - ----------------- <br /> \ ../­�­ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 8-59 2M 5-62 ATLAS o <br />