Laserfiche WebLink
FOR OFFICE USE: <br /> � � -------- - © Permit No. __/.. �.7�..... <br /> r v APPLICATION FOR SANITATION PERMIT <br /> . SIG ----- -----� <br /> ----- ------ <br /> _(Complefe in Duplicate) Date Issued ..1Z116,11A5 <br /> -- _-.--- This Permit Expires 1 Year From Date Issued <br /> a <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 /> I --? � vY`= C?_` <br /> -------------------------- <br /> JOB ADDRESS AND LOCATION----' - -------- ----- ------------- --------'Phone. -- ------��-------------- <br /> Address <br /> --- ---- <br /> Owner's Name-------� _�.-=-- -------•-------- ---------- --------------------------------------------- <br /> ----------- -------- - <br /> G'� °;d'.-------��-------------------------���'% ' `sc <br /> Address---- ��.---•---------- <br /> P h one_. -• -------- •--.... . -- --- <br /> Contractor's Narne""�`- __ _ <br /> -__ w-------- - <br /> Installation will serve: .Residence 0 Apartment House.❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other.❑ <br /> Number of living units: -J---'Number- bedrooms _` Number of baths ---I---- Lot sae ...... _.-____;___Xf____ _.--______-------------- <br /> Water Supply: Public:system Community system El Private F-1Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Send ❑ Gravel ❑ Sandy Loam [IClay Loam ❑ Clay Adobe Hardpan C3 <br /> No <br /> Previous Application Made: [If yes,date------__. :_------_l No New Construction: Yes E] No FHA/VA: Yes F1_ , <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: r <br /> (No septic tank or cesspool permitted if:public sewer-is available within 200 feet.) a <br /> Septic Tank: Distance from nearest well________________Distance from foundation--------------------Materia____-_-______---____-____---____________________- <br /> b <br /> ❑ ( No. of compartments--------------- Size-::=--' Liquid depthCapacity <br /> Disposal Field: Distance from nearest well--t4JN_ _--Distance from foundation____ -- ------Distance to nearest lot line___-_ .'------- <br /> Nu1mber of.lines_A---------1----------------------Length of each line_---1- - `- -----Width of trench------- -`tt---------------------- <br /> N <br /> "--------------- -- <br /> PeK-_- -_De th of filter materia4:__------Ed!'.__......Total length-----------------------����---- - <br /> yType'of-filter mater.iaLs p <br /> 1foundation <br /> r l' <br /> Seepage Pit: l Distance to nearest well--- E-----Distance-.from foundation_____!a_._______.Distance to nearest lot line_________________ <br /> Number of pi#s___°----- ------------Lining materiaL__$.� .e IL1lL-Size:.TDiameter-----' 3- -------Depth......- 5-_ W <br /> Cesspool: Distance from nearest well________---__-__Distance from foundation----------------_--Lining material__-___-_._._________________.___.-__ <br /> F I ___Liquid Capacity----------------------------gals, <br /> 171 Size: Diameter------------------------------------ Depth----------------- - <br /> Privy: Distance from riearest well_.-.________�:-�---------�------------------Distance from nearest building.___.____-___-_____--------------------- <br /> � ' <br /> . . r f 1 <br /> ❑ t Distance to nearest lot line----------- ;� „=------------- ---------- --- -------- <br /> II <br /> .r- <br /> Remodeiing and/or, repairing (describe:_____ <br /> - - ---- -------------------------- <br /> ------------------ <br /> ------------------------- <br /> -------- <br /> ' _______ _______________________I-.I_____.M___§_______________________________________________.-__________-______-____.-_________--__-____-_____--__________.____-_-__.-_____--__--______----__- <br /> ____________________ ____ ify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> I hereby cert <br /> ordinances; State laws, and rules end regulations of the San Joaquin Local Health District, . <br /> r and/or Contractor) <br /> I (Signed).. - a <br /> /.S!!`t- ----- (Own <br /> --------------- <br /> r (Title)------- - ---'-------- ----------- - ----- -------- <br /> By:--------------- <br /> ---- <br /> (Plot plan, showing size.of.-lot,,locaiion af_syste ,.In,relation.,to.-wells,Tbuildings, etc., can be placed an reverse side). <br /> r r <br /> I � <br /> FOR DEPARTMENT USE ONLY <br /> ► A ---- DATE °/� / _. <br /> APPLICATION ACCEPTED BY_____ _G - ----- --=------ <br /> - ---- �- ------------------------- <br /> ` DATE------------------------------ ----------------------------- <br /> REVIEWED BY-- # ---------------------------- -------------------------------------- <br /> ' -_i-- <br /> BUILDING PERMIT ISSUED DATE <br /> _ _.. . _ . .,.R-a..- ------------------ <br /> ---------------------------------------------- <br /> Alferaions nd/ re onn rid tions•----- � ------- <br /> Q �6 �_ .-t .. --- ------------------- •---------- ------------•------------------------------------------------- <br /> -----­------------------ <br /> --------------------------------------------- ------------- <br /> ------------------ ------------ <br /> It ------------------------------- <br /> ---•-- ' <br /> ----------- ----------- <br /> rj-4 ----------------------------------------------- <br /> ------------ --- ------ ------ <br /> ------------ <br /> `.."..�.”. Date - ----- --- A-el----------------------------------------------- <br /> , -- <br /> FINAL INSPECTION BY...------ c�ea-------------------•-_-.---------- <br /> SAN JOAQUIN LOCAL'HEALTH DISTRICT <br /> 1601 E.Hazelton Ara 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California <br /> Lodi,California Manteca,California Tracy,California <br /> E5 9 REV16E0 8-59 3M 3•'63 F.F.CC- <br />