Laserfiche WebLink
- ------------ ---------------Ift-41--------------------- ----- <br /> ------------------ ---------------------- <br /> APKICATION FOR SANITATION PERMIT Parrnit No. <br /> iE 4. ! <br /> :: <br /> ------------------ ----------------------- ------- (Complete in Duplicate) <br /> -----------------"""----------- -- --------`-------- -- ;This Permit Expires I Year From Date Issued Date Issued _ - ---------•-_-_--- <br /> Application is hereby made to the San Joaquin Local Health'District;,for-a permit to construct and inst the work`herein des ribed•� <br /> This application is made in compliance with County O'rdinan N �! D <br /> I_ JOB-.'ADDRESS AND LOCATION _ . <br /> . iA/----- � -----Owner's Name---------AlAi-N&Z A /� - -L <br /> k - ------------ -•- • 7---------- • Phone <br /> Address---------- _ <br /> Contractor's Name--- 1tru L _E} _ <br /> ---- ---------- ------ --- -- -------------- <br /> Installation will server Residence,�Apartment.House,(]-.,.Commercial„❑ 'Trailer.,Court,E].Motel..❑ ~Other ❑ <br /> Number of livi g units: --]---- ,Number of bedrooms�-_ Number of�bat�hs <br /> Lot size <br /> mpg ------------------ <br /> Water Supply: Public system ❑ Community system'❑ Private e th to Water Table _. <br /> Character of soil to a depth"of 3,feet: Sand <br /> - Ll ❑_ Sandy loam ] Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan [] <br /> i Previous Application Made: (If yes,tdote___..-_'_. 4) N o New Construction: Yes o ❑ FHA/VA: Yes ��NoTYPE OF INSTALLATION AND SPECIFICATIONS - ; <br /> - (No_septie-fank-ror.cesspool-permitfed,if,publc ewer.;J_.s_ayr�ailablervr!fh'jn 200Tfeet.)' <br /> Septic Tank: Distance <br /> ER' nearest �IDZeanc rom fo�undat+i►o <br /> n <br /> � L <br /> df3 Mat�e-rial--- O4I <br /> , uidepth_Noof compartens � X �-------Capa.Rci- <br /> T'� <br /> ty--1Z C --Disposal Field: Distance from nearest well__ Q___II_Distance from found ationt __ t <br /> 9 ___._.Distance to nearest lot line_==5 ._---_ l <br /> Numi3er of lines.------_� ............ <br /> I. Length of each linl d <br /> 7-4'_��-_Width of trench.----- _�` <br /> Type of filter materia) - V <br /> Depth of fi#ter mater�l____.��-___,.__-Total length___-_ __ , <br /> Q G" I i �.. <br /> �w - /r�- --------------- <br /> 9 4 r <br /> See a e Pit: Distance to nearest well____________ _ _ �Distance from foundation__' [” <br /> p g _________________Disfance to nearest lot line____..-______.._ <br /> pits w !Diameter_ -.Depth- --- ---------- <br /> Cesspool: , <br /> Dumber of its---_,Y-- _-_- -,--Lorin matenai__------------- --- Size.. <br /> r. <br /> Distance from .nea�st well_______________ Distance from foundatiom<<------------------Lining material____- _____ <br /> ❑ Sizer`"D,Iametdr------- ----------------- --------1:Depth---- ------------------------ <br /> iLiquid Capacity gals. <br /> Privy: Distance from nearest well____-_.__.____�?---------- <br /> -------- <br /> --- - _Distan� from nearest builds g_;----__-_ <br /> ----- - ---- <br /> ❑ Distance to nea`re'st lot line----- <br /> ----------Ila <br /> Remodelin and �` ""+r f' + <br /> - - <br /> 5 / r#r:`eparting' (dasc�iE�'e�: <br /> •�".'a... It - -------------•---- <br /> �. __ ------------ <br /> --------------------------------- 11 <br /> ---------- ---------------- W v-*-- <br /> -3. � - <br /> + ►C1� <br /> --------------=------------------------------------ ---------------------------------- <br /> ! hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County 4 <br /> ordinances, State laws, and rules <br /> aEnd gulatio of the San Joaquin Local Health District. <br /> (Signed). - �7_, ----I <br /> -----(Owner Contractor <br /> ------------ <br /> ) <br /> �r p _ <br /> �_ <br /> of plan, showing size of lot, locates io�ystn relation to wells, buildings, etc., can be laced on reverse side). �Y <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY----777-.?�-Q'-----------------11-------- --------------------------------------- <br /> 1 [ = <br /> DATE BY <br /> -------------------------------------------------------- <br /> DATE <br /> BUILDING PERMIT ----- <br /> . ISSUED--------------------- ---------�•------------- <br /> DATE <br /> Cr � <br /> - """ "�- """------a--Alterations ._------- -- <br /> ' _ ----------------------- <br /> ---------- <br /> ih � _7------------------------- ---------- <br /> - #I <br /> ----- -------------- ------------------------------------ ---------------------------- <br /> --------------------------------------ir._­ -----------I------------- ------------------- <br /> ---------- <br /> ----------------------------------------- <br /> FINAL INSPECT! B <br /> ea.� --- Date---------------- <br /> 'SAN <br /> -- ---- ----SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Haxellon Ave. 300 West Oak Street <br /> 124 Sycamore Street 205 West 9th Street ? <br /> Stockton,California Lodi,California Manteca, California <br /> Tracy, California <br /> F.P.❑D. <br /> i <br />