Laserfiche WebLink
FOR OFFK-E=USE7 <br /> ---------- -------------7--------------- ------- <br /> ------------------------------ ------ <br /> ---------- - APPLICATION FOR SANITATION PERMIT Permit No. <br /> ........................ - -- ------------I------------- (Complefe-in Duplicate) <br /> ........ .......­------ -------- -- --- -----­--­---- This Permit Expires I Year From Date Issued Date Issued <br /> .,1.,Application is hereby mad. m <br /> made +o the San Joaquin Local Health District for a permit to construct and install the work herein described., <br /> Th(s, <br /> 66n,isrin <br /> .-made Cop ianifih County Ordinance No. 549. TC <br /> _ <br /> JOB ADDRESS AND LOCATION _ ...... <br /> t� ) <br /> --- <br /> b _N....... --------- P�F <br /> ---------------­ ------/�- -- ---------- - 5-- C ------------- <br /> Owner's Name------ <br /> -------------- ------------------------------------- Phone---- ---------------­--I---------- <br /> Address----------J- 6.1-----------F------ y <br /> Contractor's Name-<Aj�tF,-------- - -------------- ------- --------------------r---------- ---------------- Phone------------------------------------ <br /> Installation will serve: Residence UR- Apartment House E] Commercial E] Trailer Court E] Motel E] Other [_1 <br /> Number of living units. j----- Number of bedrooms Number of baths Lot size --- 0 6 d---0-------+___------------ <br /> S ------- ----- --- <br /> Wafer Supply: Public system Ej Community system E] Private Rr__Depth to Water Table �.a ft <br /> Character of soil to a depth of 3 feet- Sand 93--"Gravel E] Sandy Loam El Clay Loam Ej Clay E] Adobe C] Hardpan E]� <br /> Previous Application Made: elf yes,dctte................... J No Construction: Yes Rr No Ej FHA/VA: Yes Rj- No <br /> ­TYPE OF INSTALLATION AND SPECIFICATIONS: 4 <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest Disfa e f f dation__-_.___-------__._.Mate <br /> ----Mptepai <br /> I from <br /> Capacity_______________________ <br /> No. of compartments_.__..-2_._._..__Size-�)(i 4 �---Liquid cl,p� <br /> ---------- -------------- ------- /- ------- <br /> Disposal Field: Distance from nearest well---5 ____._Distance from founclation-10-----------Distance to nearest lot line-r4__... <br /> ❑ <br /> Number of lines--------2-—--------------- - --Length of each line_100_�-_!0 C')__..Width of trench.....�_v----- ----------------- <br /> Type of filter material ---.--Depth of filter material-----/-7- -------------Total length.............7-470------------------ <br /> Seepage Pit: Distance to nearest wO----------------------Distance from foundation--------------------Distance to nearest lot line------------- <br /> El Number of pits--- ------------------Lining material---------------------- Size: Diameter_----------------------Depth--------------------------------- <br /> Cesspool: <br /> epth- - ------ ---------------------- <br /> Cesspool: Distance from nearest well ----------------Distance from foundation...................Lining material----...._______.___________--__... <br /> 1 0 Size: Diameter- Depth------------------------ ------------- -- ------- -Liquid Capacity-...------------------------gals. <br /> Privy: Distance from nearest well------ ------------ --- -- ______________________Distance from nearest building------------------------------------ <br /> F1 Distance to nearest lot line --------------------------------- ----------------------------------- <br /> f <br /> Remodelingand/or repairing (describe}---- ---- - ---------- -------------- ------------------------------------------------------------------------------------------------------------------- <br /> ---------------------------------------------------------- -------------- ---------------------------------------- -------------------------------------- ----- ------------------------I------------------------------------ <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,'S aws, an fes and re;1arions"Ille Joaquin Local Health District. <br /> {Signed) ----- ---- _----------- -------------- ---------------- ------------------ <br /> ------ -----------(Owner and/or Contractor) <br /> By:----------------------------- -------------------------------------------------- --- ------------------------- ------------(Title)-- -------------- -- ----- ------------- --- ------------------- <br /> (Plot plan, showing size of lot, location of system in relafion to wells, buildings, etc., can be placed an reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED By-------T,_R,0 - ------------- DATE-- --- - -----ZY_._7 - <br /> REVIEWEDBY-------------------------------_--------------- --------------------------------------------------- ------------ <br /> ------------------------------------------------------------------------------ DATE------------------------------ ----------------------------- <br /> BUILDING PERMIT ISSUED---------- ----•-------------------------------- --------------------- <br /> ----------- ------------- DATE.------------------------- ti <br /> -- ------------------------ <br /> Alterations <br /> ATE.-------------------------- <br /> Alterationsand/or recommendation$:------- ----------- ------------------------------------------------------------------------------------------------------------------------------------ <br /> ------------------------------- ------------ ---------------------- - -------------------------------------------------------- ---- ---------- --------------------------------------------------- -------------------------- <br /> ------------------------------------------------ - - - .. ......... -------------------------------------------------------- --------------------I----------------- --------------------------- ---------------­----------- <br /> --------- -----­ ............. ---------- --- ----- ---- - ---------- ------------------ --- -------------------------- --- - ----- -----------------­­-------- <br /> ----------------- -------- ----------- .............. ... -- - --------------------- ----------------------------------------- ----------- -- ------------------------- <br /> Dt. ------ -. --- y�--------• 17 --------------------- <br /> FINAL INSPECT] Y. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Noxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> California Lodi, California Manteca,California Tracy,California <br /> E.H.9 2M 1-67 Vanguard Press <br />