Laserfiche WebLink
P 7� <br /> PERMIT Permit No. <br /> 1 (� APPLICATION FOR SANITATION � <br /> (Complete in Duplicate) <br /> Date Issued .._ <br /> ?Applica+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 finance No. 549, <br /> JOB ADDRESS AND ATI N.. 1 -0/_ 9"z-r� .J,. <br /> Owner's Name------------ •---•- <br /> ------ Phone--- ---����7,Z <br /> ------••-•-�-,l �fh -Address � .- <br /> i <br /> _�- <br /> T <br /> ----------------------------------- Phone__ _Contractor's Name....... �l <br /> Installation will serve: Residence [j/Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: _ __._ Number of bedrooms ______. Number of baths _ �� <br /> !� ----- Lot size -----_,f_s ._ -•--- •-•--c*�___C�---------------- <br /> Water Supply: Public systemCommunity system ❑--Private ❑­Depth tc Watee Table ________ ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe�iardpan ❑ <br /> Previous Application Made: Yes [:] � <br /> No- w Construction: Yes Ej No r-1 �e k k --- i a A44, <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: I <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r <br /> Septic T k: Distance from nearest w/e�ll ---Distance from fpundation_ Q------ -.--.Mater�aL___�_�__.__-_____ _._______-_ <br /> No. of compartments----�i------------------Size _MM-._---.X--- d'th.� . __.._._.___.Capacity�� ---- <br /> Disposal eld: Distance from nearest well Oc �-Distgnce from £oundat _ ?---/--_---Distance to nearest lot line/-Q.___...__ <br /> Number <br /> or lines____________-_-_------,�__p.______Length of each line_ Width of trench._._ _S�`�__________________ <br /> Type.of filfer material��- ..._Depth of filter material_._..I_ ____.__._Total length-------- _--____________________ <br /> f--r <br /> Seepage Pit: Distance to nearest well_�I:CT`�______Distance •f ndation�0__ _____.Distance to nearest lot fine__ <br /> 'Number of pits------1--------------Lining material_ �� -Depth ------------------- <br /> Cesspool: <br /> f - <br /> Size: Diameter._. y, <br /> Cesspool: Distance from nearest we]-------------_---Distance from foundation--------------------Lining material------------------------------------- <br /> ❑ Size: Diameter----------------- p --Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well------ ----------------------------------------._Distance from nearest building---------------------------------- -_____ �r <br /> ❑ Distance to nearest lot ,line--------'=---=- --_.::.___ ___ = --------_-.----------------------------------------------------------- -------------------- <br /> PRemodeling and/or repairing (describe:__-_ — -•-- <br /> -----------••------- ---------------------•--- lr <br /> ------------••---------------------------------•------------- ------------------•-•------••-•---------------------------------------------------------------------------------- -•------------------------------------•- J <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 /> DAY& NIGHT r Contractor <br /> Si ned _... 5r�_fA� Tom._ �:v* ----------------- t <br /> (Signed) <br /> (moo ) <br /> 1206 So. Eldorado HO 2-7046 Title__-• ---1Ll. •-------------------------- <br /> ---------------- <br /> ------- - r <br /> 8Y •---------------•--StoFr<gaii-"Ca if;----.----- ------------- <br /> (Plot plan, showing size of lot, location of sysem in relation t ells, buildings, c., can be placed on reverse side]. <br /> 'FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BYz------------------------------- ---------== -------------------------------------------- DATE' ------ <br /> REVIEWEDBY---------------------------- --�----•---- +--------------------------- -------------------------------•-------- DATE- -------------•-----------------------•--••----------- <br /> BUILDINGPERMIT ISSUED---------------------------------- --------------- --------------------------------------------------- DATE---W-------------------------------------------------- <br /> Alterations and/or recommendations:------- ----- -- - - ----- ------------- --------------- r-\ - --- -_._--------•------. ... <br /> r 1 <br /> -------------------- ------ - -- ............. �t <br /> ------ ---- -- � ------------------------------------------------------- <br /> ------------------------------------------ <br /> -- <br /> ---------------- ------ - f - <br /> ---------- ---------- ------------------------------------------ ----------------------------- ------------ ----- -------------- ----- ..- ------------------- -------------------------------------- <br /> ----- �- ------ ------------- ----------- --------------------------------------------- --------------------------------------------- <br /> FINAL INSPECTION BY:-------- --- .. 1/.. -- ---- ----- Date_ <br /> SAN -J`O-AAQUIIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North 11C' Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> E5-9-2M 145445 ATw000 12-54 <br />