Laserfiche WebLink
FOR OFFICE USE: Z <br /> a <br /> ----------------------_----.-_.--- --------------------- APPLICATION FOR SANITATION PERMIT Permit No. Z� � 3 <br /> T-- (Complete in Duplicate) <br /> .f <br /> 0_ ----- • = 02�' Date Issued --------- .. <br /> - -. + 'rThis Permit Expires 1 Year From Date Issued z -• <br /> Application is hereby made to the San Joaquin Local Heal}h District for a permit to construct and install the ork herein escribed5�_; <br /> This�ADDR�ESSAN <br /> liatii �PL <br /> n co li ee with County Ordinance No. 549, <br /> I A <br /> .. JOBCAa aT ON �._PQ1V _-----, �� r±1f�. --• _ T /1j � . �'fD, <br /> .x r <br /> Owner's Name t7� .�-- DS-..•------r--�--- ------ QSfl -' sPhone----------------------------------- t <br /> �►/ 7 i <br /> Contractor's Name i lrx _lfl _ --------------- :.. f Phoneir7C."?!?5..•----• ":.p <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial Ar"frrailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: -------- Number of bedrooms -------- Number of baths-_--_--- Lot size -_---__- --_ ---------------- <br /> Water Supply: Public system ❑ Community system ❑ Private [,Depth to Water Table /Q- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sa y Loam Clay Loam �No <br /> y ❑ Adobe❑ Hardpan Q <br /> Previous Application Made: {lf yes'date-----------------_-) No New Construction: Yes ❑ FHA/VA: Yes 9?- No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: 4 1 <br /> (No septic tank or cesspool permitted if public sewer is available-within 200 feet: <br /> Sept n Distance from nearest well-- -----Distance from foundation__ _ ______________Material_-.-?R - T~ t <br /> tp <br /> No. of compartments----- �_'__.._---Size-Size -A__ ----___Liquid dep -------Capacity._.. <br /> P eIL_ �- <br /> -- <br /> i +�® Distance from foundation__ ....... - �Distance to nearest lottr ling_..-.�.�7-..-_-.. <br /> Dis osa eld: Distance from nearest <br /> Number of lines-.-------4--_--- <br /> --------------Length of each hne......•- •- _ �-••---Width of trench------•��--•-----••----------- 1 <br /> Type of filter ma#erial._ �-�K.--.Depth of filter material_---- ----------Total length---------k5-A9--------------------- <br /> Seepage Pit: Distance to nearest well------------- "._____Distance from foundation....................Distance to nearest lot iine--....--..--_--._ <br /> ❑ Number of pits!---------------------Lining material------------------_---Size Diameter------------------ Depth-------------- _-•-----_--•-- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation.-.------�.-- --..Lining material.---.---...-_---_-_.-_-....- ---_-. ih <br /> ❑ Size: Diameter Depth--- ------------------•----- ----------- <br /> -----_Liquid Capacity-. els. <br /> Privy: Distance from nearest well---------------------------------=----------------Distance from nearest building <br /> " <br /> > --------••----------------------- --•--- <br /> ❑ Distance to nearest lot line---------- ` ` ).... �., <br /> ------------------------------------------------ <br /> eo <br /> Remodeling and/or repairing (describe)------------------- _-`.-_------------_-•-------_•-------­---------- <br /> ----------------------------------------------------------- ---�------------------------"•=------------------------------------------# �� <br /> ----- ------------ <br /> ------------------•---------------------------------------- j <br /> s _-.- s <br /> A S ' <br /> I —. <br /> 1 hereby certify that I have prepared this application and that the work wifl''be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and`regulations of the San Joaquin Local Health District. <br /> 1 <br /> , r <br /> . � Contractorl(Signed) ---------- --------------------------------------------------(Owner and/or} <br /> By . - ,-; ... ------------------------ -----•--•-Title)------------------------------•--•---�------.--- <br /> xotplan,yshowing size of lot, location Ofsystem in�eli�tian to, ells,-b4ildings�e�:, can-be placedon reverse side):- <br /> -.I- FOR DEPARTMENT USE ONLY, <br /> APPLICATION ACCEPTED BY-----/---. ,,-Qr--- ------------------------------------------ -----L-1------------ DATE----- <br /> REVIEWEDBY '------------------------------------------------------------ ------------ DATE <br /> BUILDING PERMIT ISSUED--------------- I ------------------------------I------------:"-_J----------- DATE <br /> Alterations and/or recommendations- ----- -------- ----------------------------- ------------------- ----------------------------------------------- ... -------------•----- ----------- <br /> -2z- ------ff n� Y--------I'-------- `RgM---..31--X? ----�F-K&US' -. ��--...HLAZ c• =t7 P9601y <br /> -------------------• ----------------- '. ----- --- -- ----------- <br /> -s <br /> ----.....•--------------- -------- --- -----------------------------------• •--•-•----------•-----------...-..---•...------••--•---.-.-.._.-- <br /> - <br /> INSPECTIC3 ---------- ------------------------------------------------- <br /> SAN <br /> �--- <br /> -2--2- <br /> FINAL r�- <br /> - ---••---- 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 Manteca,California Tracy,California <br /> Ee 9 REVISED 5-59 YM 6-61 ATLAS <br /> r� R <br />