Laserfiche WebLink
----------------- <br /> ------ ------------------------------------------------------------ <br /> ?/R- <br /> APPLICATION <br /> FOR SANITATION PERMIT <br /> ----------- ------ -------------------------------- Permit No. <br /> ------- ------------------- ------------------------- (Complete in Duplicate) <br /> This Permit Expires I Year From Date issued Date Issued .... Z_ <br /> Application is hereby made to the San Joaquin Local Healfh District for a permit to c <br /> This application is made in compliance Wj* <br /> construct and install the work herein <br /> 'described. <br /> 9iF3(- It County.Qrclinance�No. 549. <br /> I A, <br /> JOB <br /> ADDRESS AND LOFATION. <br /> ............................---------------­ ............. <br /> Owner's Name ............. <br /> ... ............... ----- ------- <br /> .............. <br /> .... ..... ......... <br /> .;_�----------- ------- <br /> Address----------- - -------------------------------------- ------------- <br /> .. ........... <br /> -----------................... <br /> rkel.;V <br /> Contractor's Name. ....... - -------...... ................. <br /> .......... <br /> .......... <br /> Installation will serve: . Residence Ape ........... P ...... <br /> Number of living units: ........................... <br /> Apartment House Ej Commercial E] Trailer E] Mofell] Other 0 <br /> Number of bedrooms _:��Number of baths -1-11;eof-Size Mr <br /> Wafer Supply: PubliE system El Community system 0 Private 1�1`r Depth to Water Table�4_��ft. <br /> Character of soil to a depth of 3 fee+: Sand 0 Gravel E] Sandy Loam L] Clay Loa — Cl, <br /> Loam I El ay Ej 'Adobe Hardpan <br /> Previous Application Made: (If yes,date---------------- --- Noldf Now C' bk <br /> onstrucfion: Yei"-t 'No"" <br /> ❑ <br /> 4 FHA/VA: Yes ❑ N641 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or Cesspool Permitted if public sewer is available within'200 feet.) <br /> Sep,fic.,Tank: Distance from nearest w <br /> ----Distant rom foyiWation------ no& <br /> --------------- <br /> LJ No. of compartments-.---*" --_---------- <br /> iw* _-•"Size- ...... ---Liquid depth...... .................. <br /> -------- Capacity....k <br /> Dis osal Field: Distance from nerst well,15-0--�__Distance from foun%on_�9 0 <br /> Number of,lines.- Dist to nearest. lo <br /> line P"6-5 1� 91,............... <br /> Length of each 50'r <br /> Type of filter ma trench. ---�1_0 ---------------- <br /> _-Total length_. <br /> Depth of filter material__ <br /> Seepage Pit: - -----_------- <br /> Distance to nearest well________________------C�istance from foundation_...._........ ------- - <br /> ......Distance to nearest lot line......... <br /> ❑ Number of pits------s_.__-_:!!7::!t__-Lining material--------"--------------Size: Diameter-------••r"J ........ <br /> Cesspool: --------------Depth.......... ---------------- <br /> Distance from nearest well._____________ Distance from foundation 0 <br /> El Size: Diamete'r-------------------------------------Depth, ------------Li'ning material........................ <br /> Priv ------------------------------------------Liquid Capa6ify.. <br /> rn nearest t-- ------------------------ gals. <br /> Y:—- Distance fro-"­ar st <br /> �e e we __-- Distance ul <br /> 0 Distance to from nearest lclin;�­-----­------------- <br /> aresf lot fine <br /> Remodeling and/or repairing (describe]:--------------------------•--•.............................. ------- -------- .......... 7------------------------------------------------------ <br /> --------------------------I-------- <br /> r. <br /> ---------------------------------_-------- ------- <br /> ;---------------------------------------------------------------------------- <br /> ------------- ------------------------------------------------------------------------------_----------------_--------- <br /> - .:-:----------------------------------------------------- -------------------------------------------------------t--------�-- <br /> ---------I hereby certify that I have.prepared4his - <br /> ------ <br /> -------- <br /> application and that the work will be done in accordance with San Joaquin County <br /> ordinances, Sfife'li-4, and rules.and regulations of the San Joaquin Local Health District. <br /> �w <br /> I I <br /> ( a ----------�,A&�, I- <br /> Signe ------- <br /> L, !-4 ----------------- ------------------ --------- <br /> ey.­­--------- A ------------(Owner and/or Contractor) <br /> -- ------ <br /> (Plot plan, showing size of lot, lo�aflon Of ...... ---------------------------rifl <br /> --- ----------------------------- ------------------------------------------- <br /> system in relation to ;Wells, ------------- <br /> buildings, etc., can bee placed on reverse side). <br /> FOR DEPARTMENT' <br /> USE ONLY <br /> APPLICATION ACCEPTED BY.__:._.._-""""-'' --------- ----------------------- DATE._ <br /> BUILDING PERMIT ISSU ----•--------------- - ---------------------------------------4� .......................... <br /> REVIEWED BY-----------................._ ' " — -J- -------------------------------- DATE.'-_L <br /> ISSUED---------- -------­--­---I. .. ...... <br /> Alterations and/or recommendations:._;__..:___""-_______ --------------­----------- DATE------------------ <br /> ----------- ------------------------- <br /> --------------------------------------- <br /> -•----•------ ----------_.j................*-------------------- <br /> ----------------------­-*......... ---------------------------------------------------I---------------------------------------------------------------------------- --------------------------------------------------------- <br /> -------------- - <br /> -------------------------------------------------------------------------------------------------------------------------..........-1-1-------------------------------­ <br /> ..........I.................................. ------------------------------- ---------------------------------------------------------------------- ----------------------------------IF-----------------­------ ------------ <br /> - - <br /> -------------------------------------- -------------- ---------------- <br /> ... ------------- ------------------------------------•--------------- <br /> FINAL INSPECTION BY:---- <br /> ------------- Date...... ---------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 4 <br /> Stockton,California Lodi,California M12anteca,California Sycamore <br /> re Street 205 West 9th Street <br /> ES 9 REVISED 8-89 2M 8-61 ATLAS alifTracy,California <br />