Laserfiche WebLink
rVK Ul-l-K-t <br /> Li.S <br /> - -------- - --- ---- <br /> ----------------------I--------- --------- -------------- APPLICATION FOR SANITATION PERMIT Permit No. <br /> ------------------------------------------------------­ . (Complete in Duplicate) <br /> ----------------------------------- ----------------- --- This Permit Date Issued E fres I Year From Date Issued ............ <br /> Application is hereby made to the Sion Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made incompliance with County Ordinance No. 549. <br /> --------------------------------------- <br /> JOB ADDRESS AND LOCATION--------- <br /> Owner's Name--------- ........ ...........................--------- ....... <br /> -------------------------------------------------- --------------------------- Phone <br /> Address..._...........t7P.:V-7 <br /> --------------------------- <br /> Contractor's Name---------V_�.409, <br /> ,11'yC---------------------------- PhoneO <br /> Installation will serve: Residence � Apartment,H6use Commercial E]"'Trailer Court [:] Motel El Other E-) <br /> Number of living units; . <br /> Y Number of bedrooms __ bef bathsLot size .... <br /> Num r o <br /> Water Supply: Public system 1!rCommunity system El Private [j Depth to Water Table -----­ ft. <br /> Character of soil to a depth of 3 feet: Sand 0 'Gravel ❑ Sandy Loam E] Clay Loam E] Clay [I Adobe E?�ardpan E] <br /> Previous Application Made: (if yes,d6te---------- ----- <br /> No � New Construction- Yes 1-1 No FHA/VA-Ye, E]I No [] <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool peirnifted if public sewer is available within 200.feet.) <br /> Septic Tank: Distance from nearest well......-----------Distance from foundation......1............Maferial........ 4 <br /> El CX/S77144 No. of compartments---------------v --------Size-------------------------------Liquid:clepth------ Capaci <br /> ......... ...... <br /> Disposal Field: ----------:--------- ty....................... <br /> 8 1. <br /> Distance from nearest well-----------------Distance from foundation------------_-- ance to nearest lot line................. <br /> F-1 &j6,-ryqgr Number of lines-_' line----------------1_••--------.Width <br /> ----&t, <br /> --------------------------------Length of each line-----------------1------------Width of french <br /> Type of filter material--------------------------Depth of filter materia!-------_--------------Total length--- <br /> I .... -----------•-------------- <br /> Seepage Pit: Distance to nearest well--~_ cf <br /> - <br /> Z--___Distance Distance from foundation__-_A*0_,------Distance' to nearest lot line--____ <br /> j9- AIDjD Number of pits----- <br /> 1----------*-Lining material--- .1 <br /> <----Size: Diameter------2- ........Depth_______-- <br /> ----------- <br /> Cesspool: <br /> Distance from nearest well,____4----------Distance from foundation-------L-------71-irin—gmaterial______________________________Size: Diameter.------ --------------------------Depth---------------------------------------------------Liquid Capacity----------------------------gals. <br /> I <br /> Privy: Distance from nearest well <br /> ---------------- <br /> --------------------------------- -Distance from nearest building------------------------------------------ 0 <br /> F1 Distance to nearest ]of line------------ ---.. <br /> ---- ------------------------- <br /> 1 4 <br /> Remodeling and/or repairing (describe):...............01 00--------0YS_ <br /> I . ----------------------------------­-- <br /> ----------­--------­------------------------ -­---------------- <br /> ------------------I-----------------------------------------------I -I---------------------------------------------------- -------------------------------------------------------------------------------------*--------- <br /> 01 <br /> - <br /> --------------------------------------------------- <br /> !----------------------------------- ------------------------------------------------------------------------------------------------------------------- <br /> ----------------------------------- <br /> a-------- ----------------------------------------------------------------------------i---------------*----------------- <br /> I hereby certify that I have prepared this applicaiion;Wd thaWthe 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)--------------- <br /> By:------------ ..........�-,OVC!--------------------_---(Owner and/or Contractor) <br /> 71_1 e— <br /> . .. .......<... <br /> lrorli --go <br /> .......A------------------------------------------------------(Title)-------- -------------------- ------------------- <br /> (Plot plan, showing size of lot, location of.system in relation to wells, buildings, <br /> etc., can be placed on reverse side). <br /> FOR <br /> APPLICATION ACCEPTED BY-------L.-,I--- <br /> REVIEWED BY-------------- I --------------------------------------------------------- DATE--- ----—------- --------------------- <br /> . ---------------------------------------------------------------------*1----------- DATE------------------ <br /> BUILDING PERMIT ISSUED.-----•-•-----------�----- --------- ft:------- --------------- <br /> ------------------- -------------------- <br /> ------------- -----------------------_----------------------------------------------------------!...... <br /> --------------------------------- ------------*---------- <br /> Alterations and/or recommendations ----------- .......... <br /> ---------------- _-------------11------------------------I------- -------- <br /> ---------------------------------- <br /> ------------ -------------------------------------------------------------------------- ---------------------- <br /> ---------------------------------------------------------------------------- <br /> -------------------------------------------- ---------------------------------------------------------------------------------- <br /> -------------------------------------------I------------------------------------------------------­--------------I-------------------------------------- ------------------------------------------ -------- <br /> ------------------------------------ -------------------------------I---------------------------- ------------------------------------------ <br /> FINAL'-INSPECTION "' <br /> ----------- - Date <br /> -------- <br /> ........... ----------- ........... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street <br /> Stockton,California205 West 9th Street <br /> Lodi,California Manteca,California <br /> ES 9 REVISED 8•$9 2M 5-61 ATLAS Tracy,California <br />