Laserfiche WebLink
APPLICATION FOR SANITATION PERMIT Permit No. 1.4qj_V <br /> (Complete in Duplicate) <br /> Date Issued ------- <br /> A I // <br /> Date <br /> is hereby made to the,San J quip Local Health District for a permit to construct and install the work herein <br /> application is made in complia�nce with County Ordinance No. <br /> 59. e in described. <br /> JOB ADDRESS AICD LOCATION--- <br /> Owner's Name----4_� ------- <br /> --- <br /> --------------------- <br /> Address <br /> ---& <br /> Phoney 1 _T` <br /> - --- -- ----- ------- ------- --------------------------------------- -------- <br /> Contractor's - ------- <br /> r--/---------------- <br /> -------------------------- Phone/ <br /> Installation will serve: Residence [Apartment House El Commercial 0 Trailer CourtE] Motel E] Other <br /> Number of livin ❑ <br /> g units: Number ❑of bedroom.1 s -1/ <br /> Number of baths _�Lot size 0' <br /> Water Supply: Public system Community system El❑ Private E] Depth to Water Table 5_7Z�ft. --------------------------- <br /> Character of soil to a depth of 3 fel f: Sand 0 Gravel E] Sandy Loam E] <br /> I Clay Loam Ej Clay [I Adobe 5g, Hardpan ❑ <br /> Previous Application Made: Yes0 No Vf New Construction: Yes 0 <br /> Nojt____PHA/VA: Yes [:1 No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: I <br /> (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) <br /> Septic jank: Distance from nearest we4_j0ft6)__Distance from founclafion-10- -------Material--- <br /> P-5--k No, of compartmierifs--Z <br /> . ....... --- ---- - -------Capacity-2401,09- <br /> earesf well- Distance4rOn- foundafion--Z.19 <br /> -------------Si,e_4Z 'Y_ U * <br /> Disposal Field: Distance from n! - -_ . -Liquid depth <br /> Number of lines --- ______.Distance to nearest lot line__--_I- -- ---------------------Length of each 01 --- <br /> �Type of filter material-_ ------------Width of trench------=--- <br /> _a --------------- <br /> -------Depth of filter material------/_00,�----Total length______________ *? <br /> Seepage Pit: --------- ------------ <br /> Distance to nearest well---14-0-1%A_-___Disfance from foundation--- Distance to nearest lot line <br /> Number of pits----!---------------- Lining maferiaJ--(-Q I Size: Diameter-3-0-11......Depth_ e <br /> Cesspool. Distance from nearest well-----------------Distance from oundafian ---------------- <br /> El Size: Diameter--- from --------------------Lining material_____.._--_____- --------- <br /> Privy; ----------------------I-------------Depth--------------- -------------------------.--L;quid Capacity - ------------------------gals. <br /> Distance from nearest well____---------------__----- _---- -Distance from nearest building----------------------------- <br /> El Distance to nearest lot line <br /> ' (describe):___.__________________--__ <br /> L <br /> Remodeling and - <br /> /or repairing (describe):-_----- ---------- <br /> ------------I--------------------------------------------------------------------------------------------------------------------------------*----------------------------------------------------------------------------- <br /> ----------------------------------------------------------I—-------------------I------------ ------------------------------------------------------------------------------------ <br /> -------------------------------------- <br /> ------ --------------------------------------------------------------------I---------------------------------------------------------------------------- <br /> red this applica+ion'and that the work will be done in accordance with San Joaquin County <br /> I hereby certify }hat I have prepared -- -- <br /> ordinances, ------------------------------------------ <br /> State laws, and rules and:regulations of the San Joaquin Local Health District. <br /> _k� <br /> (Signedl)��---- - <br /> fG <br /> ----------------------------------------- WINOMI Contractor) <br /> By:---_------------------------ <br /> --------------- <br /> (Plat plan, showing size of lot, locat; - --------------------- ----- <br /> ------ -- -------------- ........(Title)------------------------------------------------- <br /> On of system in relafio wells, buildings, tc., <br /> can be placed on reverse side). <br /> A FOR DEPARTMENT USE ONLY <br /> 4t <br /> APPLICATION ACCEPTED BY---- <br /> ------------------ ---------------------------------------- DATE-----BY 47--_---------- <br /> ----------------------------------------------------------- DATE -------- <br /> ---------------------------------------------------- <br /> BUILDING PERMIT ISSUED -- ------------------------------- <br /> -1----------------------------------------------------------------------------------- DATE <br /> Alterafions and/or recomn-tendations:- <br /> ---------------4-------------------------- ------------- <br /> ----- �_?� _---�-- -------------------------------------------------------------------------------------- <br /> ---- ---- - - ------- ------- --------------------------------------------------------------------------------------- <br /> ------------- ------------------ <br /> 7­7�---------- ----------------------------------------------------------- <br /> la <br /> ........... ------- <br /> - ---------- ------------ <br /> ------ ------------------- ---- <br /> 14---------- <br /> 1 --- ------- <br /> L <br /> ----L-L <br /> FINAL INSPECTION BY <br /> ------------------- ------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 1300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California I Lodi, California Manteca, California <br /> I Tracy, California <br /> ES-9-2M , Revised 1-57 F,P.CO. <br />