Laserfiche WebLink
FOR OFFICE USE: <br /> - ---- ------- ---------------------------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. .., ✓!".. 7 <br /> - - <br /> E------------------- ------------------------------------- (Complete in Duplicate) y3 �� <br /> Date Issued .__ <br /> ___ __ -------------- This Permit Expires 1 Year From Date Issued .._..... __..._._. <br /> Application is hereby made to the San Joaquin Local Healfh 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 /> JOB ADDRESS A D OCATION, - �J t • ._____ ____. .. -t` ----- � "�` <br /> 1 n, <br /> Owner's Name.. 1 _ -- -- ------- v --------- --- `-�- ------------- Phone <br /> Address-•••_ -�------------ . -•-- -------- --------------•- <br /> C ! ' <br /> ContractorsName.--------- --•-•- •-- ----•---_ ---•- - •---- --------­ - ------ -= - - --- -- -----------•--.._. Phone................................... <br /> Installation will serve: Residence Apartment ouse ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ._Y Number of bedrooms __f . Number -f baths __ ot size .._.___ ._ _._ _........... .......................... <br /> Water Supply: Publics stem . Community system ❑ Private ( DeVClay <br /> o Water Table -------- ft. <br /> PPY� Y ❑� Y Y <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel C]-,Sandy Loam Loam ❑ Clay ❑ . Adobe❑ Hardpan ❑` <br /> } No <br /> Previous Application Made: (If yes,date--------------------) No ❑ ,,New Construction:,,Yes ❑ No ❑ FHA/VA: Yes ❑ ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> J <br /> Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material-----------------------I.................. <br /> ___-._.. <br /> ❑ No. of compartments--------------------------Size----------------------------i-Liquid depth---------------- ---------Capacity----------------...1 <br /> Dispos ..Field: Distance from nearest welL__ _�_...._Distance from.foundation_ /= -----------Distance to nearest lot line..------------ <br /> . <br /> f <br /> � <br /> Number of lines--------cA^--------------------Length of each line_..._...'X------.__-_-.Width of trench____ ____.__.-....-._______ <br /> i Type of filter material / ,kDepth of filter material..._.__ a--------Total length---.-- _ .Q___________'__.._:-_--`_ <br /> k 1- _ , , ._ <br /> Distance to nearest well------�_Il__a__...-_Distance from foundation__....I_o___._.__.D�sfiance to nearest lot lini...-_--_.___ <br /> Number of pits----------:I------_Lining material__ IC,Size:•L;atwe4er_Z__-..X-j-_Z_..Depfh----/P1--------------------- <br /> I Cesspool: Distance from.nearest well-------------- --Distance from foundation._._.--_'---------.Lining material__--_-_-----.-----._.-- <br /> ----- <br /> � r-1 Size:. Diameter------------------- -------.Depth--------------------- ---------------------------.Liquid Ca acials. <br /> Privy: Distance from nearest well ---------------------- from nearest building-------------------- <br /> F❑ Distance to nearest'lot line------------------------------------------- <br /> y Reing an r repairing (describe)_________________ �-- `— <br /> ---------- ---•- ---- <br /> . <br /> € „ <br /> -------•-•---•------------•----.--•---•------------- ---- <br /> ----- -----•------------••-•----------------------------------------•------------------ <br /> _ <br /> _> a . t <br /> -----------------------------------------------------------•.---____-_-_--______-___-____......__.------_--_--_--_-_-.__-_--_----._.....-_...__-_---_-_---___-.--____----.........__.-___.__._.-------------------------------- <br /> y fhet 1-'have <br /> I hereby certifprepared this application and that the work will be done in accordance with San Joaquin-County <br /> i ordinances, State la and rules and egulations o the San Joa uin Local Health District. <br /> ------------------------------------------ and/or Contractor) <br /> (Signed)-------------- - ------ - ----------------- --- ---- -- - -------- <br /> -------------- <br /> BY: <br /> `� <br /> SY:•-•..............• ----- r °=---------------------.(Title)--------•----------------------------- - <br /> .(Plot plan. showing size of lot, location of system I relation t wells, uildings, etc., can-6eplaced on reverse-side). <br /> FOR DEPARTMENT USE ONLY . <br /> APPLICATION ACCEPTED BY -----------------•------------------------------- DATE------ y1t�` 6 ------------------ <br /> REVIEWED BY----------------------------------- <br /> ------------------------------------------•--------------------------------•--- DATE-------------------------------•-----_-------------------- <br /> BUILDINGPERMIT ISSUED------------- --------------------------------------------------------------------- ---------------- DATE------------------------------ •------------------.--------- <br /> Alterationsand/or recommend'ations:------------ ------ -------------------------•-----•------------------••----------------.------•----------------•----------------..-•---------------•--- <br /> I <br /> --•-•--------- ---------•------------------------ <br /> 4 ---------------------------------------------------------------------------------------------------- <br /> ...---•----------------------•_____._._. <br /> FINAL INSPECTION BY:_ � ----------------- Date-----L..�-�-- - � <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 Wait Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lad],California Manteca,California Tracy,California <br /> ES 9 REVISED 8-59 2M 5.62 ATLAS <br />