9821 - Laserfiche WebLink

Home Browse Search

'APPLICATION FOR SANITATION PERMIT Permit No. (Complefe in Duplicate) �- �} Date Issued ----- I?! 5 ll - ----------- Application is hereby made to the San Joaquin Local Health District for a permit to'construct and irAfall the work Lerein described This application is made.in.compliance with County Ordinance No. 549. E _ ` A-- Loa /�,e�j JOB ADDRESS AND LOCATIONT �X -v 1 ...- Owner's. Name Cr � ------------ --------- ./2.,-=-------- ----------- Vhon ----- Address.`------------------------ /;�-Y.------ - --------- .I 'r , ,C --------------------------= 3-�- Y-0---------------------- Contrac.tor'sName--------Qui-1 ~------------------A-------------------------- -------------------------------------------- Phone----------------------------------- Installation wily erve: Residence [ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living'units: ----- Number of.bedrooms _-- - Number of baths ----I--- Lot size-----1-Lt ---YC--__- • Water Supply: Public system ❑ ,;Community system ❑ Private Depth to Water Table -4�- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam U<Clay E] Adobe E] Hardpan [jPrevious Application Made: Yes ❑ No ER New Construction: Yes o ❑ FHA/VA: Yes ❑ No TYPE OF!INSTALLATION IAND SPECIFICATIONS: ti } (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic link: Distance from nearest well-___5'V.,-Dis ance�`om foundation___;_/D-I— 1 �.r, t2r'l�.0 Na. of compartments----- /_..- :Siz :S� ��a_�--3*Liquid depth__ 2" - '. Capacity::- �1C?_ AG~ - ----- -- rj Disosa/Field: Distance from nearest well --- E}istance from To nla :iarr�fG? Wince to nearest lot line--- p Number of lines_+----_ _ -------Length of each line--------- Width- ------- ----- .9 ,. -r��--'��----------- of trench-------[�------ - � ----- Type of filter material-__. � __"Depth of:filter material------/_,Ir-"____!Total__length_---_---.---- Q_ rT Seepage; Pit: Distance to nearest well___.--_--__Distance om foundation------/.0---- Distanceto nearest lot line---- d Number of ts----=--- -._ inin materia!_/-_lC __ Size: Diameter_- - IDepth_ _____ . - _ Cesspool: Disfance from nearest well-----------------Distance from foundation------------------ material---------------------------------`__ -- --!Li!Liquid Capacity❑ Size: Diameter-' Depth ; q p Y gals. Privy;,- Distance from nearest well-------------------------------------------------Distance from nearest building-----------------------------------------. \ ❑ Distance to nearest lot line---------T----�-------- --------------------------------------------------------- ------------------------------------- Remodc, ng and or re airin describe : ------------------------- ----------------- ----------- - r' - ----------r+� l ---------- --- ----------------------------------------------------------------------------------------------- ------------------------------ -------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be do n'accordance with San:Joaquin County ordinances, Sfaf ws, and rules and regulat' ns of the San Joaquin Local Health District. {Si ned 1 - . ------ .1. k 4 g } -- (Owner and/or Contractor] �. - . Ti+fe (Plot plan, showing size of lot, location of sys+em in relation to wells, buildings,,etc., can`be placed on reverse side). a� FOR DEPARTMENT USE ONLY ,' Al APPLICAT '� ----------------- DATE --- 1 ----------- REVIEWED BY_ON ACCEPTED BY == DATE -------- BUILDING PERMIT ISSUED f - -------_°--- --; ---------------------------------------- '` ' DATE.----------G-�------=�---'---- Alterations and/or r ommehdation :_____-_ --------- - ------ - -�y�°�-� -------� - �� -•-1�.� � - - -�.l_ - ---SF-=��- xrt)-ACLezrCt� - �r �� } -------- - --- ------ ---- Al _" 411_�_c.e_---------------- .� -- - �r��-`��--------- Zvi.,!----c7r✓t.�-------.<�� --�� .--------�y =>----�7..1�.�c�---.�.� - �-a��----- �c..u�� -- f _ , - FINAL INSPECTION BY:---- ------------------------ Date ------ `S -- - --�----------------------- /� e I p VJ�LGL''I.'7 /`/p (LAA'-' �f" P✓`T 4LlJLl. �j�/6Y IV 6r (��rG�ll7 ACJ 1J�/�/�.i-�F.1 td.jf-_- 7-A SAN JOAQUIN LOCAL HEALTH DISTRICT 130'Scufh American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street' Stockton, California Lodi, Californ a '� � �� "' Manteca, California Tracy, California i ES-9-2M Revised 1-57 F.P.CO. ?� �/a.c._ �,+- rLG A'�--rJ •a�-� cv du c� e� ��7�'� � zrv�