14803 - Laserfiche WebLink

Home Browse Search

O OFFIC USE: ` ---- S> APPLICATION FOR SANITATION PERMIT Permit No. ...... -____.. ------�� 40-(:30 (Complete in Duplicate) Date Issued �. -- • lJb .------'-�-->� _______ `_ ---------------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance JJ No. 549. JOBADDRESS AND LOCATION-- -/--- _ --• '-------.dX��r4---------------------•--••---------------------------------........---------_--•---------------- Owner's Name--------------� _le_.J1 i� ----------_-- ---------- Phone................................... Address 0- —_E--- ---Qc'.�------------ L -----•----- - � -- ---------------------------- Contractor's Name........... Phone-.••----------------------•----•--- •-- Installation will serve: Residence [i-IX-partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ 6-0. .�_�umber of baths 1.... Lot.size ---- -- ----�1c -,7•-••------------ ft. --- Number a# living units: ____�. Number of bedrooms -• - � Water,Supply: Public system 9�_<Ommunity bed ❑ Private ❑ Depth To Water Table. ft. .: x Chariscterxo soil to a depth of 3 feet: Sand Q Gravel ❑ Sandy Loam ❑ Clay Loa .,❑ Clay ❑ Adobeardpan ❑ Previous Application Made: (If yes,dcite__-.___.. iI No j , ew Construction: Yes bi.-d-o ❑ FHA/VA: Yes ❑ No [j_ TYPE OF INSTALLATION AND SPE CiFICAT1ONS: (No septic tank or cesspool permitted i public sewer is available within 200 feet.) i p Distance n cor arteares___.____ � •-Distance from foundation---J.�.....--.Material--__� �_1'-�I�..k--------------` Se tic Ta Distance from nearest we $ize___, _rY��__.___Liquid depth I -0_1y�f Disposal Field: Distance from nearestwell ____�_-_--_Distance from found -o�^n__.,/_-9r_•.�!......Distance to nearest lot Number of lines-------- -------------------Length of each Iine_ 6'_V-_Z - t�_....Width of trench...6LY�___...__.____.....�J`�" Type of filter material._.;/ �-,a4:KDepth of filter material.hf__ ----------- length----,��-----_______---___ .__.- l7� R 1 Seepage Pi Distance to nearest we1L____" ..--______-Distance from foundation -- ance to nearest lot li __/............. _ Number of pits----vrZ__..-. Lining material.._ "D±:_('_Size: Diameter---- -- -------------Depth----- -,5----..---------. - Y a VCesspoal: Distance from nearest well -------!_:......Distance from foundation--_______I-----..Lining material____________________----------------- Liquid ________________ \� _ ___ Li uid Capacity t❑ Size: Diameter---------------- Deoth - --T ._-._. - 9 P ...gas. Privy: - Distance from nearest well+. Distance from nearest building. ❑ Distance to nearest lot llnbs-------------------------------------------------------------------------------------------- ;. Remodeling and/or repairing (describe)------- ----------/-��X. ----- --------- ------------------ ----- L --•--------------------••--------------------------------------•---------------- ------------------------------------------------- ------ --------•--------------------------------------------------•------------------...---------- ----------••---------------•----•------•------------ ----- - - _ ---- ----------------------------•------------•- ---------------------------------- ------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County r ordinances, State laws, and rules and rJgulations of the San Joaquin Local Health District. ' (Signed)•----- ----- � --------- ne n Contractor) . I --_ (Owner and/or BY= ` ------f •------------- = (r e)- - ----------- (Plot plan, showing size of to cation of systern,in relation to wells, buildings, etc., can bd placed on reverse side). FOR ARTMENT USE ONLY APPLICATION ACCEPTED BY--- f -- ---- -------------------------------- DATE---9I7- ------------- ---- - --REVIEWED BY. ---------------------•-- ---- --------------------------------------------- - -- -- --------•-----------• DATE I. DATE_-.------------•---•-------------------...------------------ I BUILDINGPERMIT ISSUED------------------------------------------- ----------------------------- DATE--------------------- --------------------._.--------------• ) Alterations and/or recommendations:.-----.--- -----r------------------------ ---••--- --------- -1 — f -•-- -----------�� % _ - -rte - , , -- r : f_ -------------------- -------- ----------------------- -- ---*------- ---� -- II IS- `T� - gyp . -_ - ------ ------- FINAL INSPECTION BY:----- - - -- ----------------------------- Date_._. l�7--�-.6.- r SAN JOAQUIN LOCAL`HEALTH DISTRICT t130 South American Street 300 Wast Oak Street 124 Sycamore Street 205 West 9th Street Ir Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISER 5-59 2M 5-82 ATLAS I �