Laserfiche WebLink
APPLICATION FOR SANITATION*RMIT Permit No. _--_------`----- <br /> ` )Complete <br /> --------------- <br /> (Complete in Duplicate) Date Issued -7lb-115-2) <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construq ainstall the work herein described. <br /> This application is made in compliance wit oun Ordinan NO. 549 <br /> JOB ADDRESS AND LOCATION_.--....... - ------ -- ......%eve ...... <br /> ------------- --- Phone-__ --- --------------------- <br /> � V2 2 <br /> Owner's Name------- 6--. <br /> Address-------- .... ­ -- - ----------- -----_---------------------- ----- <br /> -eZ�- _ -1 <br /> aContractor's Name.. ------ ---- <br /> Installation will serve: Residence E] Apartment House E] Commercial 0 Trailer Court E] Mortal r] Other <br /> Number of living units: -------- Number of bedrooms -------- Number of the 21.-Lot size .--------- - <br /> El - <br /> epth <br /> Water Supply: Public system Community system I to Water TableX3 <br /> of soil to a depth of 3 feet: SandGravel [] Sandy Loam 91-<ray El Loam 0 Clay Adobe e--Hardpan E] <br /> Previous Application Made: Yes E �New Construction: Yes k No El <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: `1"� Distance from nearest well----------------Distance from foundation--------------------Material-------- ----- --------------- -- ---- <br /> No. of compartments--------------------------Size-------------------------------Liquid depth--------------- _.....Capacity------------- --- <br /> Disp /Distance from nearest well-\?--.- Distance from foundation..3-d ...._Distance to nearest Mine- Z-V----- <br /> 4� R - <br /> Number of lines- . _= Length of each line_,_5---d._:�---tl-------Width of trench-- ___ --- ------ - ----- <br /> Type of filter material-!I� -------- -_Depth of filter material----/-F-_`--_-.Total length--------- -�5_14----------- <br /> Seepage Pit: Distance to nears well-IT-O.-e--.--Distance f m fo dation-10_ ------Di,fa��, to nearest lot <br /> _t.Size: 6iamefer------.3--- --- --- Dept h------ <br /> Number of pifs- :A�i-------Lining r <br /> Cesspool: Distance from nearest well--- -------------Distance from foundation-----------------Lining material-_-.----_--._-.._-----.-_-------_ <br /> ❑ <br /> aterial------------ -------- ----- <br /> F-1 Size: Diameter-------------------------------------Depth-----------------------------------------'_._.------Liquid Capacity--------------------------- als. <br /> Privy: Distance from nearest well---------............-----------------------Distance from nearest building-..__.---_--.------------------------ <br /> F-1 Distance to nearest lot line_____-----_----_--._ ----- --- ----------------------------------- --------*---- ---- - <br /> Remodeling and/or repairing Ides ribe):--------------- <br /> c � 6- ---------------N� <br /> ---------------------------------------------------------- -- ..... ..f-------- ------- -It ------ ---- <br /> .......... ..................... ---------..... .........7. -- - -------- ---­ ;� <br /> till---------- <br /> ---------- ------- -- -------------- ---------- ---------------- ---------------- ----------------------------I--------'---------- ------------------------------------------- <br /> I hereby certify that I have prepare this application and that the work will be done in aceorda with San Joaquin County <br /> ordinances. State laws., ano,rules and I lat' s of f a S n Joa lbalfh Distr2cl. <br /> t!gO <br /> 0 <br /> (Signed)..-- - -- --- -Tie w and/or 6ntractor) <br /> _,0 <br /> By:.... --------- �'ti 2t� <br /> �c ------------------------------------------------- �4 _( -_ - - ---Ift-_- ---- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> N FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY.._..--._ ----- --- <br /> -- ------------------- ----- ---------......___--- ----------- DATE_----.---- ._-_---c--- <br /> REVIEWED BY -------------- ---- <br /> ------------------------------------- ------ --- --------------------I------------------- DATE- <br /> 7 <br /> -------------------------------------------- <br /> BUILDING PERMIT ISSUED------------------------- -------------------------------------------------------- -------- DATE---------------------------------------_..-----_ <br /> Alterations and/or recommendations:_..--------......------------------------- ----------------------------------------------------------------------------'-------__--.................. <br /> ... ........ . ........­---------------------------------- -----------------------------------------­---------- ------­........ ........I----------- --------- --------------------—-------------------- <br /> ------------------- _ ------------------------------ - - -----------I-------------------­ ­­----------------- --------------11------------------------------------- <br /> - -- --------------------------- -------- ------ ------------- ------------- ----------------------------------------------------------- <br /> ---------------- --------- ------- ------------- ------ ------------------------------------_------------- <br /> r_1 <br /> FINAL INSPECTION BY: Z Date____-[ <br /> -------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West 0.1 Street 132 Sycamore Street 814 North "C" Sf,.e+ <br /> Stockton, California Lodi, Calif.,nia Marta.., California Tracy, California <br /> ES--9-2M 10-52 Revised W-2100 <br />