Laserfiche WebLink
FOR OFFICE USE: le <br /> .. ............... <br /> APPLICATION FOR SANITATION PERMITPermit No. <br />- ------------------------------------------- <br /> ----------------------- <br />- -------------------- _ --t- (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 permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATQJ--------- ------- - -- ----- <br /> xa�------------------------------------------------------------ <br /> Owner's Name---------6 ell 1.74, A <br /> ------------------ Phone------------------------------------ <br /> Address...........3?.3714------------ . <br /> _ ------------------------------- <br /> Contractor's Name------------------- a - <br /> -----.-.-.-.-.-.-.-.-. <br /> -------.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-. <br /> - <br /> ' Phone <br /> Installation will serve: ResidenceXartment Hous Commercial D 'Trailer Court EMotel EOther E <br /> Number of living units: -./---- Number of bedrooms _/---- Number of baths __/... Lot size -------/_!'p........---------_--------- <br /> Water-Supply: Public system JR Community system C1 Private ❑ Depth TO Water Table -------- ft. <br /> Character of soil to a depth of 3 feet:1! Sand (-] Gravel Ej Sandy Loam JQ bay Loam X Clay 0 Adobe'R Hardpan 0"I <br /> Previous Application Made: (If yes,da.te----------- ---- ---) NoR NewConstrucItion: Yes [N Noo FHA/VA: Yes E] No Y <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted iLp seale100 feet.) <br /> �e aterial-----X4-1Septic Tank: Distance from ridarest!wei",-1-e------Distance from foundation------Z !.....rM __­ - . . - ----- <br /> A Liquid dep�h--------5� ' apacity----- <br /> No. of compartments--,---:?-----------------Size-----^A, --------------_C Cpl. <br /> Disposal Field: Distance-from nearest,',well-- - 19- Distance from foundation---e�.e- ---------- Distance to nearest lot line,-?.......... <br /> rr <br /> Number of line -----------------__2A- 5----71 Length of each line----------!9_0.........._Wiclth of trench--------��I_ ------------- <br /> -- ... -------------------- <br /> Type of filter material...__ Depth of filter material------- --Total length---------ly- V1A <br /> Seepage Pit: Distance to nearest well-----/ !2�-----Distance from fgvndation.... Distance to nearest lot line--,/ <br /> 6 77 Number of pits._ �, Lining material__Ao94_ -------Size: Diameter__.___ ----------Depth------- -------------- <br /> NL :�w------------ 7 <br /> Cesspool: Distance from nearest well-----------------Distance fr.O' m foundation--------------------Lining material.-____________-_______._......._._._ A <br /> -y <br /> C3 Size: Diameter----'--------------------------------De pth-----------------------------------------------------Liquid Capacii ..-------_--_------------gals. <br /> Privy: Distance from nearest well-_____________________----_- Distance from nearest building___..________-.___-__________-___.___-.. <br /> Distanceto neares+ lot line-----------------------------------------------------------------------------------------------------------------------_------------------- <br /> -_ ---- ...... <br /> Remo_d91-ng_Spd/o' r repairing 1clescribe):--- <br /> tie--- --- ---- __A2-e <br /> --- ---------- <br /> ­------ ... .........­#.Z�Aa:&-------- -- <br /> ---------------- <br /> -- -------------------- <br /> --------- ------ -------------------------------------------------- ------------------------------------- <br /> ------------- ---------­----------- <br /> C <br /> I here l certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> �y <br /> ordinances, state laws,`and:`rules an_ak!gqlafions of the San Joaquin Local Health District. <br /> {Signed)------------------------------ -- --------------------------------------------------- ------------------------(Owner and/or Contractor) <br /> -------------Fltie)-------------- ------------------------------ --------- <br /> -1-------------------------- <br /> By:-------------_-_ in o <br /> (Plot plan, showing size a lo,f, Iota�ion4 sys4rn in rela 1 tufo wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------------_�0 --------------------------------------------------....... DATE.----�= --------------------- <br /> REVIEWEDBY-------------------------------------------------------------------------------------------------------------------------_.. DATE--------------- ---------- ------_------------- - ----- <br /> BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE---------------- --------------------------------------- <br /> Alterations and/or recommendations: --- --------------------------- ------------------ ------------------------------------------------------------------------------------ <br /> ---------------------- <br /> --------- 00 <br /> �e,4 4--------------------••---•-----••--------•------------------------•-- <br /> -----•---- <br /> --­------------------------------------------- <br /> ----------------------- ---------------------------------------------------- --------------I--------------- ----------*---- -------------- --;-�­------------------------- <br /> .... e 4�2 - ",4--_,7w-----------�' ----:---;!!, - <br /> ................ -------- ...... ------------------------- <br /> --------------------------------------------------------------- <br /> ----­-------------I------------------------------------- ------------­---- -------------------------------------- -------------- -------- --------- <br /> FINAL INSPECTION BY:-------_-- -------------------- Date------ ------------------------------------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street <br /> Stockton,California Lodi,California Montstca,California Tracy,California <br /> ES 9 REVISED B-59 2M 5-62 ATLAS <br />