Laserfiche WebLink
FOR OFFICE USE: <br /> - ---- ---��5,� ------------------- <br /> ----------------- ------------------------ <br /> APPLICATION FOR SANITATION PERMIT Permit No. .._ .7 ..v <br /> ------------------------- ------------------------ -- {Complete in Duplicate) <br /> - Date issued -------------------6i <br /> ___---.-_---_._________________________________________ IThis 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 LOCATION. Q. -----�_.1: f.-. ep!pvD,t� --------------- <br /> Owner's Name------------ -�LcG�----- _ ------------------ --- ------ Phone ... ,`1. <br /> Address---------------------- _/------------------------•- <br /> / <br /> Contractor's Name-�_ '�-..f'!. _1a4-- Phone <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court. ❑ Motel ❑ Other ❑ <br /> Number of living units: __1__ Number of bedroomsNumber of baths ___/_ Lot size ------------- <br /> Water Supply: Public system ❑ Community system ❑ Private >4—Depth to Water Table -- ____ ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ <br /> Previous Application Made: {If yes,date--------------------1 No ❑ New Construction.'Yes--[I No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: . <br /> [Na sep+ic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> S c. k: Distance from nearest well-----------------Distance from foundation--------------------Material____.________________..___________________._____- <br /> No. of compartments--------------------------Size--------------------------------Liquid depth----------- --------------Capacity----------------------- <br /> 1 l � <br /> os�1 I Distance from nearest well--- Distance from foundation-----�:�____....Distance to nearest lot line------ <br /> Number <br /> ----------- -----------Length of each line--: @_-1--------.Width of trench �1 <br /> .! Number of lines__________ g <br /> � VU Type of filter mate ria lar�______Depth of filter material__}__�_9 ________Total length______________________eY-________ <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation-_________________.Distance to nearest lot line_____-__--____.-. b <br /> ❑ Number of pits______________________Lining --- _--------Size: Diameter-----------------_.-__Dept h_____._________-_-_____________._ <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____.________-_-_-___-____-----____.._. r <br /> ❑ Distance to nearest Iot lin --------------------------------------------------- ------------------------------------------------------------------------------------ <br /> S - <br /> Remodeling and/or repairing (describe)-------= ----------- ------------• ------------­-- ----------- ---------•-- -•---•--------------•----------------------------------------- <br /> --•--•-------------------------------------------------•-------- -- - - --------- -�'----------•-••--------------------------------------- <br /> ------------------------------------ <br /> --------------------------------------•-------------------------- ------------------ - - <br /> I hereby certify that I have prep ared'Ais application and that the work will be done in accordance with San Joaquin County <br /> ordin,kincqCiState laws, and ules and regulations of the San Joaquin Local Health District. <br /> (Signed]- �1j� 4 s Contrac+orl <br /> By: ------------�-----•----------------------------------------------- ----- -- T<+le ------- --- <br /> (Plot <br /> ( } <br /> (Plot plan, showing size of lot, location of system in relation tow IIs, buildings, e+ , can be placed on reverse side). <br /> a FOR DEPARTMENT USE ONLY <br /> r <br /> i4 yC n, <br /> REVIEWED BY-------------------------------------------=---; ------ :----------------------------------------------------- DATE-------------- �-��--�=------------- <br /> APPLICATION ACCEPTED BY == = DATE .... <br /> BUILDINGPERMIT ISSUED-------------------------------------------------------------------------------------------------• - DATE-------•-------------------------------•--------------------- <br /> Alterations and/or recommendations:---------------------------------------- -----------------------------=---------------------------•----------------------------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------ ------•---••-------------------------------------------------------------------••-•--------- <br /> ------------------------------ -------------------------------------------------------------------------------------------••--•---------•----------------------------------•-­ ........-------------------------------------- <br /> -------------------------------------------------------------------- <br /> . <br /> FINAL 'INSPECTION BY ._._• ---- ---- ' ---------------- ---- « Date-------- ------------------------------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> r B.9 RCv16EQ B-69 F•P.M0.2M 6.60 <br />