Laserfiche WebLink
4 `k APPLICATION FOR SANITATION PERMIT Permit No. ._.. 1� .- <br /> 10 (Complete in Duplicate) <br /> Date Issued <br /> Applica*ion is hereby made to the San Joaquin Local Health District for a pe to construct and install the work herein described. <br /> This application is made in compliance withounty Ordinance No., X49. <br /> JOB ADDRESS AND;L CAT [/ -------- ----- --' -- - -------- -•-•-----------�--------- -----•-• �� ----- --------� <br /> 4IVA1�- ----------------- ---._. Phone <br /> Owners Name { i d <br /> Address_-------------------------� �-�--� -------------------------- ------------- --------------------------------------------------------- -•---_-----•-------•- --- <br /> Contractor's. Name_.. lJ' l4'1.,51 � �-------- - Phone �0 <br /> Q~- <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other <br /> ti Number of living units: Number of bedrooms __1.... Number of baths . _.-.. Lot size __3W__ X_-XS-7________________-__-_________-_ <br /> I Wafer Supply: Public,system_❑ Community system ❑ Private o Depth to Water Table4_0 ft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam E] Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> Pievious Application Made: Yes El No X New Construction: Yes No E] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> r ...-.-...p.;,, f <br /> Septic Tank: Distance from nearest welL,�.�.______Distance from foundation__Z�___'___._.Mate�rial_____=_._.__.__.__-___.______ __ __. <br /> No. of compartments__';!-__.___.____.. --Size f:___ x-luU.___.Litiquid depth_,_SZ7_. -..:___ -Capacity t Q. .__-__ ._,_ <br /> Disposal Field: Distance from nearest well....._-____..._Distance from foundation___`:..__.._, -Dis+ance'fo`nearest lot line_________________ <br /> ❑ Number of lines--------------------------------- -Length of each line---------------:---------------Width of trench------------------------------------ <br /> Ty Depth of filter material_______________ ......Total length___._____________----___----__-_________._ <br /> Type of filter material____________________ p <br /> r _ _ r« <br /> Seepa%ge Pit! Distance to nearest well.. _____--Distance from f• dation--�_----___.Distance to nearest lot lige__�r ____-..0 <br /> •of pits.�rN.?_��--Lining materia Size:Size: Diameter__.—' _..._..---_Deptn_A-------------------------- <br /> Number <br /> Cesspool: Distance from nearest well-----------------Distance from foundation......--------------Lining material--------.._._...___--_----_._--______ <br /> ❑ Size: Diameter---------------------------- --------Depth------------------------------ ---------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well--------------------------------- ------------Distance from nearest building-------------------------------•---------. <br /> ❑ Distance to nearest lot line..... "------------""--------------------------------------------------------------------- <br /> Remodeling ----------------------------------- <br /> and/or repairing (describe: = ---------'---- - ----- <br /> - - ---- <br /> --------------=-------------`------------------------- --- - --------------------------------------- <br /> ------------------------------------- -------------------------------..---------------------•-_-------------- ----i--------------------- ----------------------•------------------­--------­------------------- <br /> -------------­---- <br /> ------------------------------------ -------------- `----------------------•------------------------- -------•-----------------------------------------------------------------------------------•--------•- ------ <br /> I hereby certify that I e epared this ap lication and that•the-workwill-be•doneiin accordance with San Joaquin County <br /> ordinances, State laws, an'. rules nd regulation of the San Joaquin Local Health District. <br /> ---- <br /> (Signed) -------------------- ---- - - -- ------ --------------- - -- ------- ---- --- ne <br /> --[Ti+lel h r a <br /> or on a or <br /> (Plot plan. showing size o of, ocation of system in relation' wells, buildings,'efc., can be pla le on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---- ----------------- <br /> -------------- -: --------------------------------------------•--------- DATE-----. - ------------ ------------------------------- - <br /> REVIEWEDBY-------------------------------- ---- -- -- -'�� - ---------------------•---------- ------------------ DATES:-- -�- --•---------------------------------------- <br /> BUILDINGPERMIT ISSUED--------------------------- - �---- ---------------------------•------------- DATE-------- --- -------------•------------- <br /> Alterations and/or recommendations:-- --------- =' ------• -----------------------------------------•---------------- -•-.-��� <br /> ------- - - ------- - --------------------------------------------------- -- -•------------------------ <br /> f <br /> ------- - <br /> - ------------------ --------------------------------------•----•--------------- <br /> -------- --- ------------- -- --------------------------- -----------------------------------------------.------------------------------------- <br /> ----------------------- •---•--------------------- -------------- --- - -- ---- ------------ ------------- <br /> FINAL INSPECTION BY:_-- 1 ---------------------------_-- Date....... ------------------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 Was+ Oak Street 132 Sycamore Street 814 North "C" Street <br /> r Stockton, California Lodi, California !Manteca, California Tracy, California <br /> R` J `l�'Ii4saa6 ATw000 12-54 <br /> 4 H <br />