Laserfiche WebLink
FO OFF�! USE: <br /> .... .. APPLICATION FOR SANITATION PERMIT Permit No. <br /> -------------------------------- <br /> --------------------------------------------------------- (Complete in Duplicate) 3 <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 complianc-e with County Ordinance No. 549. <br /> JOB ADDRESS AND <br /> -�OCATION------------- --------- ----------------------- ----------)---------------------------------------------_---------- ----------------------------------- <br /> Owner's Name....------ ----------- --- ------------------------------------------------------•----------------------- Phone_1-'(J. ' ?'Y�� <br /> Address <br /> ------------------------------------------------------ <br /> Address............ -2- <br /> u---�Contractor's <br /> -- -------\......_ -------------------------------------------------------------------------------------- ........................ <br /> NamI ----t,- ------- . .---­------------- ----------- ------------ <br /> Installation will serve: Residence F <br /> Apartment House [] Commercial E] Traile�Court [3 Motel C] Pther% I A.4-4 1 <br /> Number of living units- Number of bedrooms ----I_ Number of baths ._I-____ Lot size s ------------------------------ <br /> Water Supply: Public system Er-60mmunity system I-] Private Ej <br /> Depth TO Water Table ft. <br /> Character of soil to a depth of 3 feet: Sand El Gravel E] Sandy L:6am F1 Clay Loam El Clay El Adobe 0--"Hardpan ❑ <br /> ---1 <br /> Previous Application Made: (If yes,date-------------- - No NK�Ne-w Construction: Yes IQ--No 1-1 FHA/VA.. Yes D No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool p6mitted if public sewer is available within 200 feet.) <br /> I <br /> ,Sppfic Ta k: Distance from nearest well-----------------Distance from foundation....................Material................................................. <br /> I <br /> No. of compartments----------- --------------Size-------------------------!! Uquicl clepth--------------------------Capacity----------------------- <br /> I! W '��4f <br /> Disposal Field: Distance from nearest well_N0-*--._.....Distance from foundation�+JP..........Distance to nearest lot line___ .......... <br /> Number of lines!-------A------------------- ----Length of each line*-Z!�. 'ei If -ench -Z <br /> % ----------- ------ -._-_--...-Total <br /> (i.........Width of tr -----------r---------------------- <br /> Type of filter maiterial.._!��-----Depth of filter material --------._Total length...._;4 ............................ <br /> Seepa e Pit: Distance to nearest well---- -------Distance from foundation-----f 0..........Distance to nearest lot <br /> Number of pits"'..-t--------------Lining material___- --_.Size: Diameter---A3............Depth---- <br /> Cesspool: Distance from nearest well---------------- Distance from foundation---------- --------Lining material--..--.--_--___--_--_--_-_----._____ <br /> ❑ Size: <br /> aterial--------------------_--------- <br /> Size: Diameter-- ----------------------------------Depth----------------------------------------------------Liquid Capacity............................gals. <br /> Privy: Distance from nearest well---------------------------------- ------------Distance from nearest building------------------------------------------ <br /> ❑ Distance to nearest lot line-.------- ------:--------------------------------------------------------------------- ---------------------------------------------- <br /> Reyleling A�an lor 4— --------- <br /> ---- - ------ -------------- <br /> . .. ................... <br /> _",5.7_6- ----------------- <br /> ------------------------------------------------------------------------------------------------------ -------------------------------------------------------------------- ............ -------­--------------------- <br /> I hereby certify that I have prepared this application 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 /> k-PL --------------------------------------- ---------(Owner and/or Contractor) <br /> (Signe --- --- ------- ---------- <br /> 7 <br /> By:.---.... .. ------------------- ----------------------------------------------------------------------(Tif _Kj......>�7 ------- - ----------------- <br /> (Plot plan, lowing size lot, location of system in relation to wells, buildings, etc., can be placed on reverse i a). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY........ &--- . ................ <br /> --------------------------------- DATE....-- <br /> REVIEWEDBY----------------------------------------------------- --------- ------------------------------------------------------------- DATE............................................................ <br /> BUILDINGPERMIT ISSUED--------_-----------------m---------------------------------....................................... DATE--------------------------------------------------_------- <br /> k � <br /> s Alterations <br /> ATE--------------------------------------------------_------- <br /> Alterations and/or recommendatioq$:----------------- --------- ---- ------- ---- --------- ------------- -------------------- 4 <br /> -1----------I--------- -----• <br /> -- <br /> _41.3----—------- <br /> ----------............. <br /> -- ---------------I----------------------- ------------------------------------------------------I------------------ ---------• <br /> ----------------------------------------------V <br /> ............I­--------------I................................I----------------------­­­------------------------------------------------------ -----------------------­................................................ <br /> ..........................................­­----------------I.­-------- ------- ------------- ------ ------------------- --------------- ----------------------------------------------------------­------ <br /> ----- ------ ------------------------------------ <br /> -a-1 <br /> ---- ------- <br /> FINAL INSPECTION BY:------ ------ -- -------- <br /> Date - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 8-59 2M 5-62 ATLAS <br />