Laserfiche WebLink
FOR OFFICE USE: <br /> ----------------­---------- ---------------- --------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> ------- --------- ..... ..... ------------ ------------- <br /> - ----------- ------------------ -- (Complete-in Duplicate) Date Issued <br /> .--.---------------------- 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 herein described. <br /> - <br /> Th F-0 0 1 <br /> application is.made in compliance with County Ordinance No. 549. 711—/A-) 0 5 —0 <br /> VE ----—---ie�........... <br /> JOB ADDRESS AND LOCATIOK- - - ------ --- <br /> ---- --- ---- ------ L <br /> Phone----------------------------------- <br /> Owner's. Name-------t,' ---------- ------ ------ ----------------............... .. ------------------------------------------ <br /> r ----------------------------- ----------- <br /> ----------- --- ------------------------ <br /> Address------------------I - ------ I ..ZK <br /> -------------- ----------- ------------ <br /> - �Z__/ ------------ Phone-' -------- <br /> --------- ------------- --------------------- ------- ----- ------ - ---------------- :---- -------------------- <br /> Contractor's Name-------- -------------- Trailer Court E] Motel E] Other ❑E3 <br /> Installation will serve: Residence Apartment House ❑ Commercial F] <br /> Number of living units: Number of bedrooms Number of baths. Lot size ----- --- -------- -------- ------- <br /> Wafer Supply: Public system El 'Community system El Private [ Depth to Water Table ft <br /> Character of soil to a depth of 3 feet- Sand C] Gravel [3 Sandy Loam L] Clay Loam [!r Clay E] Adobe E] Hardpan F_ <br /> Previous Application Made: (If yes,date.. .......7...... ) No F1 New Construction: Yes E] No E] FHA/VA. Yes 0 No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: X <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 ......-_-_---._.-.......___.........-.-....-a <br /> ElNo. of compartments...---- ------------------Size------------------ - -----------Liquid depth--------- -- ---- ---------Capacity------ ----------------I. <br /> Disposal ield: Distance from nearesf well--47;F. ----Disfan'ce from foundation---lel-/-------Distance to nearest lot line--- <br /> Number of lines ---------/----------------------Length of each line_____j4.40-------------------Wicith of trench_��-`------------------------- <br /> 5' IV --- <br /> Type of filter materiat----------- - --------Depth �f,filfer miferial...... Total length--I-I qG------------------------If------- <br /> Seepage Pit: Distance to nearest well.-.--/ -:'Distance to nearest lot line-.!PP.......Distance from foundation...-Ze- ---------- <br /> ---x!12-'----- Size: Diameter------- Depth--.-- - -- ----- <br /> ❑ Number o� pits.-- -----.1-----.----Lining material--- <br /> ion ----------- ...Lining material-_.:._._.___------------------------ <br /> Cesspool: Distance from nearest well ----------------Distance from.foundat <br /> -------gals. <br /> n Size: Diameter- -- --------- ----- ----- ........Depth......................... . -------------------------Liquid Capacity-- ------------------ <br /> Privy: Distance from nearest well-------------------------------- ------ - ------Distance 'from nearest building---------------------------------- <br /> 0 Distance to nearest lot line _. I Lr <br /> ------------------L------------------------------------------ ------------ ---------------------------- ------------------------- ------ <br /> Remodeling and/or repairing [describe):------- ------------------------ -------- <br /> ............. ---------------- -------------------------------- ------------------- <br /> ----------------------------------------------------------- Aekf-w.!::z 'S -— - ------------I------------------------------------------------------ <br /> -- - -------- -------- <br /> --------------------------------------------------------------------------------------- ------------------------------------------------------------ <br /> ---------- --------------­------- <br /> -----------------L----------- ------------------ ------------------------------------------------------------------------------------------ ------------------------------------------------------------------- <br /> I her <br /> certify that I have prepared this application and that the work will be done in accordance with San Joaquin Coun <br /> ordinances, State laws, and rules and regulations <br /> ( B - of"the San Joaquin Local Health-District. <br /> Signed_ ... . .. ----------- ---- - --------- ------- <br /> ----- -- ------- r and/or Contractor) <br /> - ------ T --- - --------- ------..------------- ----- --- - ---- <br /> y:----- -------------- - <br /> (Plot <br /> plan, showing size of lot, location of system in. relation 0 wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED - ------- ------------- -------------------------- --------------------------- <br /> -------------- --- ------------------------ DATE----------- ------------REVIEWED BY-----_----------------------- ---------------- - ----------------- -- --------------------------------- <br /> BUILDINGISSUED---------------------------- ------ ---------- ------------------------ ­ ­------------- DATE----- ---------------------- ---:---------------------•---- <br /> Alterations and/or recommendations:_----------------------------------------------------------------------------------- -------------------------------'•-----------•-•------------------------ <br /> ----------------- ---------I-------- ---------------------------------------------------------------------------- ------------ --------- ------------------------------------------- <br /> ----------------------------- <br /> ­-------�­----------­'­---------------------------------------------------- --------- ----------------------------- ----- --------------------------------- ------------------------------------------- <br /> ....................I------------------- - - -------------------- -- -- -----------."r- -------------------­ - �-------------------------_ _--------------------------__---- ---- - -- --------------I-----------­ <br /> ------------------------ - ------------------- ------------------ ---- --------------- <br /> ------------------------- --------------------------- -------------------------------------------------- - - --------------------- <br /> FINAL INSPECTION BY: -- ----- ----------------------------------------- <br /> - ---------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hassillon Ave. 300 West Oak Street k, 124 Sycamore Street 205 West 9th Street <br /> Stacklom,California Lodi. California MOnteCOr California Tracy,California <br /> E.H.9 2M 1-67 Vanguard Press <br />