Laserfiche WebLink
74 <br /> APPLICATION—FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) Date Issued <br /> Applica-1-ion 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. S49, <br /> qfA.A�. <br /> JOB ADDRESS AND-LOCATION'------!A--o-,-,�- O�---/_1--- -----------I------ --- -�r-------------9--"--------------------••-----•--• <br /> ----------------------*---------------•--------------- <br /> Owner's <br /> -----*---------------------- <br /> -------------------- --------------------------- ---------------- <br /> Owner's Name------ ..... ... -------- Phone-------A)------------------------- <br /> Address................... n - ---- --------------- -------- ------ .................................................................................................... <br /> Contractor's Name--.- % -- --------------------------- Phone_ib_._�a-3fTl <br /> ----------- <br /> Installation4ill serve: Residence Ba" Apartment House E] Commercial E] Trailer Court E3 Motel E] Other E] <br /> 0 <br /> Number of living units: -1----- Number of bedrooms -1 A <br /> ---- Number f baths ---- Lot size _---4.4 --------V <br /> --- -- ------------------- <br /> Water Supply: Public system El Community system 171 Priv4 ;;"Depth to Water Table Art. <br /> Character of soil to a depth of 3 feet: Sand 0 Gravel ❑0 Sandy Loam ❑E] Clay Loam ❑E] Clay ❑El Adobe &a"'Hardpan ❑ <br /> Previous Application Made: Yes 0 No V New Construction: Yes VNo Cj <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Se nk: Distance from nearest well---;5P01-___Distancq from fou d tion_-__.-----tO�----------Maferial---- <br /> n Q ion -------------------------- ---------- <br /> pe No. of compartments--------�t------------- _Xtt.Liquid clepth--A-211 .........Capaci 11.414�Pl? <br /> Disposaj,eFfield: Distance from nearest well401....Distance from foundation----fA#---------Distance to nearest lot line--.----.____---_- `� <br /> Number <br /> ine----------------- <br /> Number or lines--------I-------------------------Length of each line---------i-Q---------------.Width of * <br /> trench ----------------------- <br /> Type of filter material___A-*-tA/.........Depth of filter material___-j-7 ..-___.__.Total length-----gl ` <br /> _V------------------------ <br /> Seepag Pit: Distance to nearest well_____qo-------------Distance from foundation......Z. <br /> t- <br /> O.0--- Distance to nearest 1&*e-----U--- _ <br /> Number of pits---.-- ---------------Lining material-A..-__ -----..Size: Diameter.....SO-._.--.._-_-Depth.._I ----_-_----__ <br /> Cesspool: Distance from nearest well_________________Distance from foundation________-___._._.- Lining material-______----.-_--.---.-_-------._--- <br /> ` U <br /> ❑ <br /> aterial--- -------------------------------F71 Size: Diameter------------------- ------Depth----------------------------------------------------Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well--------- -------------------------------------.-Distance from nearest building-.--------.-_.------_---_--_-____----_-. <br /> ❑ <br /> uilding------------------------------------------ <br /> El Distance to nearest lot line---------------- - ------------------------------------------------------------------ <br /> O ..P <br /> ----------------------------------------- <br /> Rem eling <br /> ----------------------------------------Remde4ing andr repairingdescribe) % 0-- <br /> 1--2----,0----�------------ <br /> -- <br /> -- <br /> ----------------- <br /> L — S <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 regulations of the San Joaquin Local Health District. <br /> (Signed)_ ---------------------_:--------(Owner and/or Contractor) <br /> --------------------------------------{Title)--pal <br /> (Ti le ---- <br /> - ----- -------------------------------------------------------------------------- <br /> By:-------- ----------------------------------------------- t )------aqv -------------- -------------- <br /> 1cl size <br /> (Plot plan, showing size lot, locat!'n of system in relation to wells, buildings, etc., can be placed or0reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-------------------- --- ----------11 ----------------------------------- ••------------ DATE---------_;�-------------------------------------------- <br /> REVIEWEDBY------------------------ --------------------- - --------------------------- ------------------------------------ DATE--------------------- <br /> BUILDINGPERMIT ISSUED-------•--•--- --------- ------ ---------------------------------------------------------- DATE-------;___!___ --------]�---------- ---------------------- <br /> Alterations and/or recommendations:....... ------- --------\1_1 ------Q�------------------------- <br /> f--r-___._--.- <br /> --------- - -------------------------------------------------- <br /> ------------------------�_t---.--_-d---_--_--..-.-2,- ----------- ---- -- ----- --------------------;;;��-------I---------------------- ---------------Isr-------------------- <br /> C, <br /> ............. ------------%�------- --------------­----------- <br /> 5 AA - --------------6------ ---k -—----- <br /> ---------- -------------------------------------------------------- <br /> I--------------------------------------------------------------------------------------------------------------------------------------- <br /> ----------------------------------------- -------- <br /> ----------*----------------------------------------------*----------- <br /> -------- --- --------- ------------------------------------------------------------------------ <br /> - - <br /> FINALINSPECTION BY.-______- -------------------------------- Date--------------------------------- ------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> E:r,-9-2M 145446 ATWOOD 12-54 <br />