Laserfiche WebLink
ell <br /> D <br /> < � <br /> APPLICATION FOR SANITATION PERMIT Permit No. .•l..............�_ <br /> rt� {Complete in Duplicate) <br /> This Permit Ez ires I Year From Date Issued 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 LO ATION--_/ .3-7_ _ <br /> --- ---------- <br /> r� <br /> Owner's Name___-. Phone--------------------- <br /> -- ----------------- <br /> Address--------- --,.-----;Z` /4 � -------C <br /> Contractor's Name '-----------•----••-------- ----------------------------•"----------------------•----------- ------ Phone---•---•------•----....-------- <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other E- <br /> Number of living units: �Z-- Number of bedrooms .�-- Number of baths _-4-. Lot size -- !- '►!(--- t3Q_______________________________ <br /> Water Supply: Public system ❑ Community system ❑ Private Sj Depth to Water Table S70! ft. <br /> Character of soil to a depth of 3 fee+:' Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ® Hardpan ❑ <br /> Previous Application Made: Yes ❑ No Q New Consfruction: Yes ® No ❑ FHA/VA: Yes ❑ NOR j <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material --_ <br /> ----- <br /> ❑f t No. of compartments Size----- <br /> ---------------------------Liquid depth--------------------------Capacity--------- <br /> Disposal Field: Distance from nearest well.-.--- -.-.-Distance from foundation--------------------Distance to nearest lot line.-----------_-. � <br /> ❑ Number of lines-----------------------------------Length of each line------------------------------Width of french-------------------_----_-------_-- <br /> Type of filter material-------------------------Depth of filter material-----------------------Total length--------------------------,------------- C,A <br /> =f Seepage Pit; Distance to nearest� iwell----Ja4_!------Distance from foundation•j��ai-.-..Distance to nearest lot line----'67...... � <br /> Number of ts---_--, p �--------------Lining material------..aC. . :----Size: Diameter --Depth----P--,J"-.------------------ <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material--------------------____---.---------. (� ' <br /> ❑ . Size. Diamefer--------------------------------------Depth-----------=----------------------------------------Liquid Capacity-- -------------------------gals. <br /> Privy: Distance from nearest well--------------------------------------------------Distance from nearest building-------_..----------___-----.------_----. <br /> ❑ Distance to nearest lot line------------------ ---------------------------- ----------------------- <br /> Remodelin and/or re airin i(describe]:------ f <br /> ---------------------------•------------------•-----------------------------••------- ----------------------- ---------•------------------------------------------------------------------------------------------- <br /> ordinances, certify <br /> laws, and rules and regulations li the San Joaquin L-- or ---_-__------------------------------------------------------------------------ my <br /> I herebycertif that 1 have prepared this application and that the work will be done in accordance with San Joaquin County <br /> Local Health District. <br /> Sined ---------------------- <br /> --------------------_ _ <br /> ----- ---(Owner and/or Contractor) <br /> g )-------- ------------- ----- J-1-I& <br /> By:--------------------•------------------------------------------------------------------------------------------------- ------------(Title)------------------------ ------------------ <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------------- ' - ------ ---•---- ---------------------------------------- DATE----- �r -� ------------ - - e <br /> REVIEWED BY"__ :r---- =---------- .---`-.- .- - - DATE--- <br /> BUILDING PERMIT ISSUED------ ---------------------------------------------- -------- DATE <br /> Alterations and/or recommendations----------- ----------------------------------- ----------•-•------------------------------------------------­----------------- <br /> ------------- <br /> ---------­----------------...... <br /> -------------------------•----------------•-- •---------------------------------- ------------------------------------------- ---•-------------•---••----------------•--------------------- ------------------------- <br /> ----- ----------------------------------------- ---------------------------------------------------- <br /> -------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------- <br /> FINAL INSPECTION BY- ............. •-- = ------ Date-----41%27/,,�5-,/o---------- <br /> --------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West dao Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, Califoreia Tracy, California <br /> s ` <br /> FS-9-2M Revised 8-'59 F,P,Co. <br />