Laserfiche WebLink
OR OFFICE USE: <br /> -41 <br /> - , <br /> ` APPLICATION FOR SANITATION PERMIT " <br /> ---- ------------------------------------------ <br /> ­­ <br /> ---------------------------------------- Permit No. ._....__....... <br /> - -------------------------------------•----- --------- (Complete in Duplicate) v" <br /> --- -------------------------------------- Date Issued ......---_----_--.-.- This 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 her ' described. <br /> This application is made in compliant nth Cou _ _ r mance No. 549. 14 <br /> 1 t r , ' <br /> JOB ADDRESS AND LOCATION._ &L� Q_ !C .- '1�AR 1� -� �-.-.-..[ A[N1.1.V.__ -. WJOOA��[T". <br /> --- <br /> `� �'T -? = . ---------------------------------- <br /> Ise PhoneOwner's Name_ <br /> Address e # C-- <br /> ....-•-------------------------------------••-•-•-•-- <br /> IContractor's Name......... ---------------------------------------------------------------------------••••.........---.........._. Phone.................................... <br /> Installation will serve: Resident ' Apartment House ❑ Commercial ❑ Traa/iler Court ❑ Motel 0 Other ❑ <br /> l Number of living units: lumber of bedrooms umber baths /.... Lot size ----- ti :................................ <br /> Water Supply: Public system ❑ Community s tem ❑ Private D,pth to Water Table #. <br /> ,6 <br /> Character of soil to a depth of 3 feet: Sand tj Gravel ❑ S ndy Loam ❑ Clay Loam�VNo <br /> lay E] Adobe❑ Hardpan ❑ <br /> Previous Application Made: (if yes,date--------------------) No New Construction: Yes ❑ FHA/VA: Yes [:] No <br /> TYPE OF INSTALLATION_,AND-SPECIFICATIO_ NS: <br /> No sa tic tank or cess ool—ermittedif ublicsewer is-arailable,within'.200 feet. <br /> S #ic Tank:,,r Distance from n}earest welLn-_f�_ --. Distance from foundation__-__---•___.-..-...Material.........:---------.............................. <br /> eF0�i 'V C� No. of compartments----''=--r---------=--=Size`_--__--___---t-__-_----Li uid de th-_. _-------------------Ca act J <br /> Disposal Field: Distance from nearest well--- ----Distance from foundation..... --------Distance to nearest lot tine..-............. G <br /> AM`VC(0A1 Number of lines -----------------Length of,-.each line------- ---_ _.-_._.Width of trench-t---- <br /> Type of filter material.-.- -e441.-.Do th of`filter ri aterial_....-f -- <br /> - --- length._-.. :.�1r __________________ R <br /> 4ter . <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation------------------..Distance to nearest lot line................. <br /> ❑ Number of pits...-.-----_---.------Lining material-----------------------Size: Diameter------------------------Depth---------------------.----------- <br /> E Cesspool: Distance from nearesf well--------------r Distance from foundation--------------------Lining material�---------------................ <br /> ❑ Size: Diameter------------- - �----------•---.-Depth----------------------------------------___-----liquid Capacity=---------------------------gals. <br /> Privy: Distance from nearest'Wdil:---_-------------------------------- --- --..-Distance from nearest building----':-_----_---..----..-_-----------. <br /> ❑ - _ ------------------•----•----------------------•----..--•• --.._..-------•-------------- <br /> Distance to nearest,lot,line._'_:---�f._'- �, r - • k-).1__-,, ) _ t <br /> I ^- <br /> 1 Remodeling and/or repa'ii•ing (describe)------'--- --- ----•----•--------------------•-•--•---------------•_---- <br /> S 3 <br /> :-_____.-.-....•.........................................................••--•-___-_-••---_---_____----__--..--------_---- _........-__............_•..-_.--•--• <br /> ----------------------------------------------------------- <br /> + <br /> -•-•--•. ------------- --------------------------------------------------•-------• --------------------- -------------------------------------- <br /> F fl <br /> II hereb�r certify that I have prepared Ais-application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulationf of the San Joaquin Local Health District, i <br /> (Signed)..... ....-. .drf�LrL i.��2''. ` ---------------------------------------------------------------------------------------(Owner and/or Contractor) <br /> `- '=_.: ._ : ---------------------__-_-.:...........:.......:.:. .:........•---------------_--_=---(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 DEPARTMENTi-USE,014LY <br /> APPLICATION ACCEPTED BY......._-.-1-...►--IC-•.i`----- ----------------- --------•-----• --••- -•-•-•-•-•-•-•- DATE..----- r .. <br /> • ---------------- --------------------------------------••--------------------------------------- DATE------------------------•----------------------------------- <br /> BUILDNG PERMIT ISSUED------ -----------------------------------------------------•-------......._.•. ---------------------- DATE.----------------- Olt <br /> 44 <br /> Alterations and/or recommendations <br /> : --------------------------------------- -•-----......---------------•--------- ...r ti <br /> .................................•......... -------•-- -•- --- - -------------- ----- -• -- <br /> I r W All <br /> ----------------- ------I---------- ... -- --- -- -- - ------- ------ ...... <br /> Vie- <br /> FINAL INSPECTI ------ Date---- ..-7.... -.^Tlj -- -------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9Th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED S•59 YM 8-61 ATLAS _ �� <br />