Laserfiche WebLink
Vol <br />Y------- <br />APPLICATIOWFOR SANITATION PERMIT PermitNo " <br />- - <br />(Complete <br />in Duplicate) <br />Date Issued. <br />rein described. <br />Applica-l'ion is hereby made to the San Joaquin Local Health District for a permit to co�sfrucf and install the work he <br />This application is made in . mpliance with County Ordinance No. 549. <br />— -------------- --------- --------------------- ------------------------------- ----------- <br />ITION.. - ------- % <br />JOB ADDRESS AND, - LOC/ ------ <br />e--2 <br />--------- Phon ----•--------- <br />n <br />Name--- -•... . .1 l, <br />------------ <br />----------------- --- <br />one.,1 <br />----- <br />--- - ----------------- ---- <br />------------------------- <br />Ph3... <br />.. ----------------------­- t <br />------------------------- <br />---------- <br />Contractor's Name ------ ­-- ------- -- Ap!fm , enf House El Commercial' El 'Trailer "Court C]T Motel [-I Other 0 <br />Installation will serve: Residence= I . .* . - k - . A- <br />. 11 1 Lot <br />size of bedrooms NUn)b6r of baths /­ _Lot size <br />0 <br />Number of living unt s: _-- Nu t I <br />unity Water Supply: Public.syst Commsystem 0 Private Depth to Wafer Tableclay E] Adobe [HardpanCharacter of soil to a deptLf 3 feet. Sand -B-GravelaH —Sandy Loam 0 .�Clay Loam <br />❑ ❑ <br />Previous Application Made -i A <br />Yes ❑ No [&Iew Construction: Yes 0 No <br />TYPE OF INSTALLATIONIAND SPECIFICATIONS: <br />(No septic fank,or c spool' permitted if public sewer is available within 200 fee <br />. 11111 41 <br />from f 7undafion --------------------- Material --------- A: -------------------------------------- <br />pfi TiQnk: Distance from nearest well -----------------Distance f 0 <br />± --------------- rLiquid depth -------- ! ------------------ 'Capacity <br />-------------------Size---------------- <br />No. of �ompartmenfts,I I <br />Distance from; % m f ndation ---- 4-z� ...._-.___Distance to nearest lot line --- A .......... <br />Id: <br />il�p.,2xi L nearest well: ------ ------- Distance fro ou <br />Alm*VIP, 40 , I /- P ........ ---------- Width of french ----- ;�Y ----------------------- <br />- r Number of liries Length of.each line ----------- <br />, All ------------ --- f .'Depth of of:each <br />material___:_ ----- -- Total length <br />Type of filferfm,5ieria ------- -1 -------- <br />'from'f'o�u-n�dati'on-'----'.-.� ------------ Distance to nearest l6i'line ------ - -------- <br />Pif Distanc �to nearest well ---------------------- Distance i <br />Seepage 1 11110 :.... Size: Diameter ----------- I ............. Depf k ------------------------------ <br />umber of.pits <br />?N --------- ---Lining material" <br />- - - - - - - - - - <br />----------- Distance from foundation -------- : ---------- Linifig material ---------------------------- <br />Cesspool: Distance from nearest well--- - I - . Z <br />i t -----------Liquid Capacity ----------- - -- -------------- gals. <br />171 Size: Diameter --------- ---------------------------- Depf h ------------------------------------------- I - <br />' ' I I :--: --- Distance from' nearest'6uilding -------------------------- <br />Privy: Disfanc-e from' nearest well-------------------------------- . ; ­.. I- . — j,. - -- � I . I <br />'i ------- -­ ------- -------------------- ---------------------- ----------------------------- ----------------------- <br />40 t line. <br />0 Distance to nearest 1 $ o ---------- 7-- <br />jUl <br />---------------- ! ...... --------------------------------- <br />-------------- : <br />Remodeling and/or repairing {describe ------------------------------ I ----------------------------------- <br />;j , , � .. - *. %*%. ,* k� - v h ------------------ ------ ------------------ ----------------------------- <br />---- -- ----------- <br />------------- ---------- I ---------------------------------------- 1 ------------------------------- I - - <br />------------ --------------• <br />1 4, ----------------------------------------------- ------------ -------------------- <br />----------------------- ------­------------- ­---------------------------- ............ <br />---------- ----------­----- --- -,j .4 1 <br />ji 4 ­ . - ---------------------------------------- <br />-- ------ ------ - --- --------- --- - ---- - <br />- <br />--------- - ------ --- --------- <br />--------- I -- hereby -- certify . - ­ that - - have - prepared - - - -- this - application -- and that the w . ork will be done in accordance with San "Joaquin County <br />ordinances, Staf& laws, a U1017 -9 f tine Joaquin Local, Health..District. <br />a rules , and reg 9 <br />x <br />;of, <br />---- j ----,O ner and/or Contractor( <br />---------- <br />(Signed) -------- �? 40 �7�j ---------------- ------------------------- ----------------- - -- --------------------- -------- <br />-- ----------- <br />�e ii <br />- --- - - ---------------- <br />- --------- re <br />-- - - -------- <br />-------------- ---------------------- <br />By: ------------- ------------- -------- - ---------- --------- <br />------------- - <br />(a4 --p <br />(Plot plan, showing size of lot, location 'of stem in relation to wells, buildings, etc., can be' placed on reverse side). <br />FOR DEPARTMENT USE ONLY <br />0 - DATE ------------------------------------------------------------ <br />APPLICATION ACCEPTED BY_______________ - ofj ------ ----------------------- ­ I I-- <br />'2 -6 ---- ----------- <br />---------- DATE -- <br />REVIEWED BY------ ---------- --------------- — ------------ <br />0 1 W-4-1 4,� ------------------ <br />BUILDING PERMIT ISSU91D -------­--- -------------------------- DATE ----------------------------------- <br />ill! --------------------- --1 ---------­--------------- ---------------------- --------------- <br />Alterations and/or recommendations: ----------------------------------------------- --------------------- <br />1111 -------------------------------- : ------------------------------------- --------------------------------------------------------------- <br />-----------­----------- ---------- 1 <br />----------------I--•----------- - -------------- <br />----------------------------------- -----------------­----------- <br />------------------------------------------ 1 ----------- ---------------------- ------- ----------------------------- ----------- ------ ------------------- <br />--------­------------------ <br />----------------------- -------------- 0 ---------- I ------------------------------------ --------------- ----------------------------------------------------------------------------- ----------- <br />------------- --------------------------- ----------------------------------------------------------------- I ------ --------------------------- ---------------------------- - <br />------------------------------ ­­ ---------- <br />FINAL INSPECTION BY:---------- ------ - <br />------------------- Date ------- �M ------- ---------- -------- --------------------- <br />yi: -------- - --- <br />SAN JOAQUIN LOCAL HEALTH DISTRICT 814 North re <br />"C" Stet <br />130 South American Street 300 West Oak Street 132 Sycamore Street <br />Stockton, 'CaliforniaC� <br />Lodi, California Manteca, California Tracy,, California <br />ES -1-2M Revised V -2100 <br />