Laserfiche WebLink
tv <br /> O�\ )11 <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) Date Issued ---717:1. <br /> Application is hereby made to the San Joaquin Local Health District for a*permit to construct and install the work herein described. r <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND/iLO.C6TION------ ------- ---- --------5i....... - - ------ ---------------------------------- IP <br /> - -�it_x ------ ---- <br /> ------(�...�one------------------------------------- <br /> Owner's Name �_dl --------C_y--------- <br /> -------------------------- ------------------------ <br /> - - ---------- <br /> Address---------------rol­194_�_, ------t_7—------"_--------------C <br /> Contractor's Name---------------- ----------------------------------------------------------------------------------------------------- Phone..--------------------------------- <br /> Installation <br /> hoie---------------------------------- <br /> Installation will serve: Residence Apartment House [] Commercial F <br /> Trailer Court E] Motel [j Other ❑ <br /> Number of living units: Number of bedrooms ___-_/Number of baths .__/__ Lot size ---,14 ------------------- <br /> Water Supply: Public system El Community system 0 Private r'%"­Depfh to Wafer Table i -30 <br /> - ff. <br /> Character of soil to a depth of 3 feet: San)(E;L Gravel [I Sandy LoamK Clay Loam.E] % Clay 0 Adobe El Hardpan El <br /> Previous Application Made: Yes E] Noj Now Construction: Yesjg:–No 0 FHA/VA- Yes E] No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) <br /> ticT " --------------------Material-------------- ---------------------------------- <br /> ic Ta k: Distance from nearest well_________________Distance from foundation <br /> Size--------------------------------Liquid Liquid depth----------_--------------Capacity----------------------- <br /> No. of compartments----- -- --------____--Distance <br /> r st of line____ -------- <br /> Dispos 'ell: Distance from n <br /> Disposal <br /> el <br /> nearest well - --- ------D�stance from foundafion___,j, _6________-Distance to neare <br /> Number of lines Length of each line---_ :11), --------------- <br /> L _______.Width of fr( -------- <br /> Type of filter material-- of filter material___ __Total length___. " - --------------------------- <br /> Seepage Pit: Distance to nearest well-_/0-0-- -------Distance fro fo dation__ _ __._____Distance to nearest lot line____5_________ <br /> Number of its____/--------------Lining material_h -,Size: Diameter__- LP <br /> Cesspool: Distance from nearest well-----------------Distance from foundation------A. .........rLin'ing material_______-_____..___._-----------_____Size: Diameter---------------------------------------Dept h--------------------,------------------------------Liquid Capacity---------------- -------gals. <br /> Privy: Distance from nearest well------------ ---------------------------------- -Distance from nearest building---------------------------------- ------ <br /> ❑ Distance to nearest lot line------* ---------- ------ <br /> ------------------------------------------------------------------------------ ---------------------------------------- <br /> Remodeling q --- ------------ ------------------------ --- ----- <br /> V-o ---------------7 <br /> ------------------------------ - ----------------------------------------- <br /> ------------------ - <br /> ----------------------------------------------------------- I--------------------------------------------------------------------------------I----------------------------------I------------------------------------- <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 re uiafions of the San Joaquin Local Health District. <br /> (Signe ------------------ ------------------------- ----------------------------------<;�(Owner and/or Contractor) <br /> ---- - --- ------------ <br /> By:------------------------------------------------------------------------------------------------------------------------------------(Tif le)------------------------------------------------------------._.. <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ------ ------ is--- --- -------------------------------------- DATE ------- <br /> 2 . ------ DATE /------------- ----------------- <br /> REVIEWED BY-------------------------------------------- - --------i------- - ------------------- <br /> BUILDINGPERMIT ISSUED------------------------ --- -------------- ------------ ------------------------------- DATE------------------------------------------------------------- <br /> 9 --------------- <br /> Alterations and/or recommendations:"-------------------- --------------------------------------------------------------------------------------------------------- ----------- <br /> ---------•----------------------------------------------------------------------------------------------------------------------------------------------------- ------------- --------------------------------------------- <br /> 11 ----------I----------------------------------i---------------------------------I------------------------------------- <br /> ----------------------------------------------------------------------------------------------------------- -A-it <br /> ----------------------------------------------- ----------------------------------------------------------- -------------------------------­--------------------------------------------------------------------------- <br /> ------------------I------------------------------- ---------------------------------------------------------------------------------------------------- ---------------------------- --------------------------------------- <br /> FINAL INSPECTION BY:-- -------------------- - -------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 309 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M Revised 1.57 F,P.CO. <br />