10839 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. /�� '_ - \:(Complete in Duplicate) Date Issued ------X44 f Application is hereby made to the San Joaquin Local Health District for a Permi# to constr�ct and install the work herein described. This application is made in with County Ordinance No. 549. t 1 • JOB ADDRESS AND LOGATI'ON--__ _Rt. 4, Box 766$ last ha. on welde Of Ca -Denter Rd - -- ------------ Owner's Name---Jack_ & AglleBl rMh, '', Of the ,9� _I+'i'eeway onto Qt .— --------- ------ A dress------------- 116 E. Market St. , 1 , HO. 3-4255 Hm. - -----------------•------•--.-_. -------•-------------•----------- tract ' D to e. tic Tank Service, Inc. , 1 Ho. 3 8729 Contractors Name e ;� ----- -------------------•------ -----------=---- Phone..: ------------- ------------ i Installation willserve: Residence Aparlinent House ❑ Commercial ❑ Trailer Cob rt! ❑ Motel ❑ Other ❑ xg , 1-- V° ? 1 5� acrnea Number of ivin units: ____ Number of bedrooms _ _ Number of baths ________ Lofls¢e ___________________________________________________________ Water Supply. Public sysffem [3 Community system E] Private ® Depth to Water Table 4, 5__' ft. Character of soil to a depth of 3yfeet/$and 0 Gravel ElSandy Loam E] Clay Loam [I Clay E] Adobe® Hardpan ❑ Previous Application Made Ye"s'Ej. No [I New Construction: Yes fr] No ❑ FHA%VA: Yes ❑ No Y TYPE OF INSTALLATION AND-SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ° i / ; I Septic Tank: Distance fro nearest well-____________._Distance from foundation--------------------Material--------------t__-___________...____.-______ Exining No. if compartments-------------------------Size--------------------------------Liquid depth _ ----Capacity-.--------------------- f F f ------ - --- -- -- - Disposal Field: Distarice,from r'earest well------------------Distance from foundation_________________-Distance to nearest lot line------_______-__- t Ex&piing Numbe'of lines------- -------------------------Length of each line------------_--------- --I-Width of trench-!----------------------- ------ T� e'ofifilter material`_-----------------------Depth of filter material-----------------I--- -Total length--------__---__---___,___•__________-____ Seepage Pit: Disence to nearest weIIT].QQfR_Distance from foundation_____ I]iste to nearest (o# (ine__--- �-� lr 5 ( rl • ,� 2 t ® " Number of pits-------1----------�pining material__Y_QCk-------.Size: Diameter__.... g-------rDeptn--------,�-------------------•- Cesspool Distance from nearest well____-,-----___-Distance from foundation_______________ �` 4 ----.L�ntn material---�--------------------- -------- ❑ Size: Diameter---------------------------- ------Depth---------------------------------------------=---_Liquid 'Capacity----------------------------gals. Privy: Distance from nearest well----- ----- ---- ---------------- , _____--__._Dista Distance from nearest building_-_---•______________________ :. li ❑ Distance to nearest 1,0,0i1ne` _=A ----- Rernodeling and/or repairing (describe)-,k_r= &dd�.ilg*raee l�.g2 pi$ to__eA_at_1_ng- qy8' p1Tt F -- -- -- --------------------------------------------- --- ------ - --- f -;a - -------- ----------- ------------ -------------- --•---------------------------------------••------------------------#------�-•------I— ----- ------•------'-------------- --------------- I hereby certify that I have prepared this applicationland that the work will be donelin accoda c with Sari..Joaquin County ordinances, State laws, and rules and .regulations of the San Joaquin Local Health District. (Signed) Del-t-a------eptie-- T-� __3_e 'v--1e1et ne ----�----�--------------�---- ------------ -----(O�wner and/or Contractor') By: �r.) 40 SY' .Perr Wanthan-------------- p 4-------------------------------------- - -IT . kriteG _ , � - (Piot plan, showing.size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). i r � 4 FOR DEPARTMENT USE ONLY •` APPLICATION ACCEPTED i8 - -- -------------- ------------------------------------------ DATE----------- ----- - r REVIEWEDBY------------------------------------ ---- - - ' --------- ------ DATE------------•---- � �� f-- BUILDING PERMIT ISSUED--------------------------- -- --- -------------------------------------------=------ - DATE- { — ------- Alterations dor recommendations: - "( '=_ ' , y / 1 ""' ------------------ ---------- - - r / 11 - --- --------------------------- --------' ----"----'------------------------------- ------------------ ------------`�'----- - -----------_---------------`------------------------------ I-- -------------------------- i -----------------------------•-----------------`"ti ' L--------------------------------•--------------------------------------------------------------------------- 0 FINAL INSPECTION BY:. Date ---- ------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 134 Soufh American Street 300 West Oak Street 132 Sycamore Street 914 North "C" Street ` ' Stockton, California Lodi, California Manteca, California Tracy, California ES 9-2M Revised 1.57 F.P.CO. f / f