Laserfiche WebLink
FOR OFFICE USE: <br /> - <br /> -------------- <br /> � <br /> ' --------------- APPLICATION FOR SANITATION PERMIT Permit No. -_A� ,3......... .._ <br /> ----------- -------- (Complete in Duplicate). <br /> ------------------------------------------------ - <br /> ___._._ This Permit Eic fres 1 Year From Date Issued Date issued <br /> t <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 /> t <br /> .___ _� 71JOB ADDRESS AND LOCATION.. Jc_ _ f` /, <br /> Owner's Name..... -----� - <br /> --- -------- Phone? <br /> Address-------------------------- <br /> -------- --•---------- ------ •_-- ----------------------- ----------------------------------­----------- <br /> ---------- <br /> ----- -?- ------'----- <br /> - <br /> 7 Phone. i ° -Contractor s NameC ] / <br /> Installation will serve: Residence Rj-"Apartment House Commercial ❑ Trailer Court ❑ Motel ❑ Other [❑ <br /> Number of living units: ___ __ Number of bedrooms . Number of baths __ __-Lot size __ x­r_________________ r <br /> Water Supply: Public system [R<ommunity system ❑ Private ❑ Depth to Water Table _44ft. <br /> ' Character of soil to a depth of 3 feet: - Sand [] Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [Hardpan ❑ <br /> Previous Application Made: {If yes,date--------------------I No ❑' -New Construction: Yes ❑ No [�HA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No Rseptic tank or cesspool permitted if public sewer is available within 200 feet.) I { <br /> Se Distance from'nearest'well_"__-___'__Distance from foundation--------------------Material_________._.___--_-__,__.___-_.____-_'_- <br /> t <br /> - -------- <br /> . . <br /> No. of compartments-----___------- Size----------------------------- Liquid de th____.____---__--.--- -_--Capacity .- <br /> Di osal <br /> Distance from nearest well-AC`A�C�__Distance from found on---�t _=____.Distance to nearest lot <br /> •, ' Width of trench _S�_. , ! <br /> �upmber of I':nes___..__ <br /> Length of each line. �� nth -------------+ 1" <br /> .____Total .le <br /> .� <br /> Type of filter mafenal�_ .___ Depth of filter material___ ___ ___ gl ______ _ ____` <br /> Seep ge Pit: Distance to neare welly ____ Distance from foundation__________________.Distance to nearest lot line_ <br /> �. �. <br /> Number-.of pits'_"= __•_------------Lining materiaLRD_ <br /> Size--0iometer__. _ �rDepth_.._..._______ s_ ___.-. m <br /> Cesspool: Distance from"neareft well-----------------Distance from foundation------------------- Lining material----------- _ I <br /> _________________ '__y___ __. <br /> ❑ i Size: Diameter--------------------------------------Depth_----- - --------------------------Liquid Capacity------------------------_-gals.: <br /> a <br /> I Privy: ��`-''•Distance from.nearest well___---------______________-__:_:._____.__...__._Distance from nearest building.--------------------------- __` 1 <br /> ❑ �_ ----�-`--"------------------------------- <br /> Remodeling <br /> -------------------- 1 --- <br /> lot~line-----------------=-=- --------- -------_---•------------.....---------•------ .. <br /> Remodelin` and/or re air3n describe --------------- <br /> ------------------ <br /> } ` <br /> Is ante o neares <br /> • __ _p ________.,____________________________________________________________________________.____.___._.____________....__•..__.___.___, a <br /> `----------------- <br /> ------------------------------------------------------- --- -- - - - ------------ ---------------------------- ----- <br /> - ' <br /> ------------------ ---------------------- ----------------------------------------------------------------------------7--------------- <br /> I hereby certify thatPI have pr peied'this•-appiication and:that-.the work will be.done:in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District— <br /> (Signed) -- ------ '\ F---- -- `------------ ---------{ ontractor) <br /> By:---------------------------------------- -------'_------------------------------------- -- ----- ITifle)------ ---r---- -------------------------------- ------- <br /> [Plot plan0howing size of lot, location- in relation wells, buildings, Pi-can be placed.on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> t ' � <br /> APPLICATION ACCEPTED BY _ - DATE -1 i <br /> REVIEWED BY---------------------------------- -- ---- -- -- - - -- -------- DATE.......\-------------- ------- <br /> BUILDING PERMIT ISSUED- ------- 1 - i----__'- _.--- ----- 1 , DATE.----- %y'°`-- <br /> /L � . <br /> Alterations end/or recommendations---_-------�_... _ ._.__ ---------------- __,�!` -_a:�` _ _._._t_'T-�__ -f._f. <br /> 2�C <br /> ---------------- •` ---------- -- �" `-e`- - '1 `� �c2.• f `' `f`- �...---.`....... ... <br /> ------- --- z— tea- ?. <br /> ------------ - - - --- _ ------------------ <br /> _ <br /> z <br /> i2l---- <br /> Z <br /> FINAL INSPECTION BY:�. ._._.__ ° -Cr��`P Date G -- <br /> Q� <br /> r� ... <br /> AN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1401,'A.'Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Str et <br /> s '`� <br /> 5tocklon,California Lodi,California Manteca,California Tracy.,California TR <br />