Laserfiche WebLink
FOROt.QCE UZE: <br /> 7/f <br /> ------------ —2 <br /> ------------- APPLICATION FOR SANITATION PERMIT j Permit No. .1 <br /> ............... <br />--------------------------------------------------------- <br /> (Complete in Duplicate) <br />------------------ -------------- --- ------------- ..... . This Permit Expires 1 Year From Date Issued Date Issued ............... <br /> Application is hereby made to the San Joaquin Local Health District for a permitocan d <br /> ,j ' iltruct an instal he work he irvdqscrib <br /> This application-.*s-ma in <br /> d * compliance with County Ordinance No. 519 al- <br /> � <br /> B Ar, <br /> A 4-1/ <br /> 1C IC <br /> Owner's .. .. . <br /> Narne­ .......... - ---------------------------------------------- <br /> Address......421 1-1-1120- -­ ----------- <br /> Contractor's Name - - -- --- --- <br /> -------------------------------- ------------------------------------------ PI <br /> 2(e <br /> ­ ... ..M7... <br /> Installation will serve: Residence @g-"Apartment House ❑ Commercial E] Trailer Court 0 Motel 0 Other 0 <br /> Number of living units: Number of bedrooms --- Number of baths Y.- Lot size -/0­11;� .A--7­-3"- ­­1------------- <br /> Water Supply: Public system I - <br /> Community system El Private 10"'Depth to Water TableT-O- ft. <br /> Character of soil to a depth'6f 3 feet: Sand 0 Gravel [] Sandy Loam [] Clay Loam [] Clay J-] Adobe El-lHarcloan 0 <br /> Previous Application Made: (if yes,date____________________) No E] New Construction: Yes fro E] FHA/VA: Yes [I No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool p6rmiffed if public sewer is available within 200 feet.) <br /> r r <br /> Septic Tank: Distance from nearest well--------Distance-from foundation---40--------- .. . ..... ......1-1...... <br /> Capacity. <br /> .. . . <br /> ... .... <br /> No. of compartments___ IQ-----------------Size--,J& -------Liquid depth----f.­70,------------ <br /> Disposal Field: Distance from nearest well_......_.Distance from foundatioi; to nearest lot line,- X' <br /> ;iy----- <br /> Number of lines------IC-21- Length of each Iine-jA0---7/e-----------Width of trench------7.91" <br /> r F------------------ <br /> Type of filter material- -- ----Depth of filter material--- ---Total length-....ZS-Z............Seepagq,plf: Distanceto neare nclation- .S1......Q:istance to nearest lot line- ........ <br /> U <br /> Number of pits---A ----------Li�ing materia Diameter..... -----Depth----z9-17.........•------ <br /> -orn nearest well-----------------Distance from foundation--------------.--.Lining material..._.._______________........______._ <br /> Cesspool: Distance from <br /> El Size: Diameter--- <br /> ------- -----------------------Depth--------------------------------------------------.-Liquid Capacity----------------------------gals. <br /> Privy: Distance from nearest well_________________________________________ _______Distance from nearest building-______________.___..----_.___.__._______. <br /> 0 Distance to nearest lot line-----------­ -------------------------------------------------------- <br /> Remodeling and/or repairing (describe):--------------------------------------- <br /> -------------------------- --------------------------------------------------­------------------------------------------------------------------------------------------------------------------m-------- <br /> -------------------------------------------------------- <br /> ---------------------------------------------------------------------------­----------------------------------------------------------- <br /> ------------------------------------------------- ------------------------:--------------------------------------------------------------------------- ----------------------------------------------------------- <br /> I here4ify that I have pre ared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances at".4 lawspnd rule regulatio of 2then Joaquin Local Health District. <br /> ------------ ------- <br /> --- - ---- ----- <br /> --- ------- <br /> -- ---.... ---I-------------------------- ---,Owner and/or Contractor) <br /> (Signed) <br /> By:............ ----------------- ...... ............ --- ------------------(rifle)--- ................... -------------- <br /> ........... <br /> (Plot plan, showing size. of lot, location of em in relation to we uildings, etc., can be placed on reverse side). <br /> FOR DJPARTM! k <br /> PT USE ONLY <br /> APPLICATION ACCEPTED BY--- --- -- ------------ ---- ---- ----------- ---- -------------------------------------- DATE----- `� I <br /> REVIEWED <br /> ATE------ <br /> REVIEWED BY.------------ --------------- --- ----- ---------------- -------------------------------------- DATE------------------ <br /> ---------------- ----*------------- -------------- <br /> BUILDING PERMIT ISSUED------------------- -------------- <br /> - -- -------:D,------- DATE... <br /> ------�­----------. <br /> Alterations and/or recommendations:' -6...7 <br /> - ------------------------------------------------------------I----------­----------I---------------------------------------............­------------------------------------------------------------------------------------ <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------­------------------------ <br /> ------------------------------- ------------------------------ ------&----------------------------------------------- -------------------------------------------- -----------­*---------*INAL INSPECTION INSPECTION BY:-. & <br /> ----/------ Date ------ <br /> -­-----------------­--­--- <br /> SAN JOAnU1M LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Sireet 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Wdlr California Manteca,California Tracy,California <br /> ti't hEVJSED B-57 2M 5-61 ATLAS <br />