Laserfiche WebLink
APPLICATION TOR SANITATIO_N PERMIT'_'. Permit <br /> _ (Complete in Duplicata) <br /> Date ised <br /> This Permit Expires 1 Year From Date Issued su ___._ __�� <br /> !?r•-•zit-0--is <br /> Application is hereby made to the San Joaquin Local Heal+h District for a permit to constru6 and install'the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. } I <br /> JOB ADDRESS AND LO N .. ¢ r---•--.T------7,- - - <br /> Owner's Name...._. <br /> ` - - _..... -- •••------ ----- ----------•........-••••••-• ••• ---••---•-•-......•••-- ....._......••-- Phone... - :._». ...... <br /> Address__ ._.....-t ---- --•----------=� <br /> - -------------•-- <br /> Contractor's Name.-••---•----•--- L ---•- y!----------_-_ + Phone ' <br /> Installation will serve: Residence �� r 1 i <br /> Q�partment House ❑ Commercialy0 Frailer Court ❑ Motel 0 Other ❑ <br /> Number of living units: __ _ Number of bedrooms J__ Number of baths _-, -- Lot size ---� �.�--------.......... <br /> Water Supply: Public system ❑ Community'sgstem [1 Private Depth toJJWater Table lQ_ ft <br /> Character of soil to a depth of 3 feet: Sand B-Gravel E] Sandy Loam ❑' Clay Loam❑ Clay ❑ Adobe❑ Hardpan ❑ <br /> Previous Applicaf ion Made: kYes ❑ No Rr—New Construction: Yes ❑ No �Hi4/VA: Yes ❑ No ❑ <br /> TYPE OF-INSTALLATION AND SPECIFICATIONS: t <br /> (No septic tank or cesspool permitted if publicsewer is available within 200 feet.) <br /> � � T <br /> I <br /> SepticTank: Distance from nearest well- Q_. ....Distance from foundation_Z -------Material....................... ______ <br /> a <br /> - u•�__._-.--__- <br /> . <br /> No. of corn artments....•_._�---•--------Size----- Liquid depth.. �1 ----------- <br /> r <br /> Disposal Field: Distance from nearest well.__--------Distance from foundation.___.!.........Distance to nearest lot lines�.__._.... <br /> Q� Number of lines.........` .____.. ___•____ff._. Length of each line-._9Q------1_Q_.-.--Width of trench.........kyr`r _ <br /> r Type of filter material__.Sr___ ?�aO_'Depfh of filter material_./_9'._______Total length____ .SA.......__________________ <br /> Seepage Pit: Distance to nearest-well--------.............Distance from foundation--------------------Distance to nearest lot line................. <br /> ❑ Numbeiiofpits......................Lining material--------.-.---_-----_Size: Diameter..............---------Depth_._•--------------------------- <br /> Cesspool: Distance from nearest well.................Distance from foundation-----------------...Lining material-------------------------------------- <br /> ❑ Size: Diameter----..............................---Depth------------------------------------------•----------Liquid Capacity__----------------------gals. <br /> Privy: Distance from nearest well---------------------------------------_---------Distance from nearest building................................_____-.-_. <br /> ❑ Distance to nearest lot line...............................-....................................................-.......... <br /> Remodelingand/or repairing (descrI ibe)------------- ------------------------------------------_-----------------------------------------------•--------------------...................... <br /> I <br /> j <br /> he e6cer ► y that I have prepared this application and that the work will be-done in accordance with San Joaquin County <br /> ordinances, 5t .e ws, ands les and regulations of the San Joaquin Local Health District. <br /> k <br /> (Signed) -----------••-•---....... = = -------------- --- ----------- -------------------------------------------- ------ nor and/or Contractor) <br /> By:............. ---------------------f ---_------- ------- . -- --•------...................--------------._._{T'itle) t -----•----......'�. --.-.. <br /> (Plot plan, showing size of lot, I cation of system in ation to wells, buildings, etc., can be placed on reverse side). ' <br /> i FOR PEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY lQ� - --•--- --------•-----•------------------ DATE•---- ...........--•---•-•------------•--- <br /> REVIEWEDBY---------------------------••........L-...............................•.-•--•-•.•-------------------------------------- DATE------------------------------------------- <br /> BUILDINGPERMIT ISSUED-----------------------------•----•--- ------------ ..............................•--•-•--••• DATE............................................................ <br /> Alterations and/or recommendations:------•----------•----_-:..........................................................................................-...............------------------------- <br /> --------------•-----..........................--------•••••• •-----------•-------------------•-----.........................-----•--------•-•-•--------------------------••---•-•................. <br /> 1 <br /> --.....--•-------•---•--._._... •--•-------------------;­7 <br /> -----•--•------•-•--------------•--------••-----•------------•------------•----- <br /> ---•----•---...._.. ............................... .. ---------...............................•--------------------------------------------------------------------------- <br /> FINAL INSPECTION BY:.......-- I-.. -.......`= •-••••• •...... Date.....................- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Streat 814 North "C" Straef <br /> Stockton, California Lodi, California Manteca, California Tracy, Californle <br /> ES-9-2M Revised 8-'59 F.P.Co. ? <br />