Laserfiche WebLink
APPLICATION FOR SANITATION PERMIT Pe-rm:it_ S-6- <br /> --------------- <br /> (Complete in Duplicate) <br /> A Issued J� <br /> This <br /> Date <br /> is ca-lion'is hereby +o.the San Joaquin Local Heaffh District for a permit to construct and install the work herein described. <br /> application is made in compliance with County Ordinance No, 549. <br /> JOB ADDRESS AND LOCATION------ <br /> - --------------- -- ---- <br /> _P. h-?� ---- --------------- ----------------------------------------------------- <br /> Owner's Name_----------- V0 �t4------------------------------- <br /> ---U1.4----------- , <br /> Address--------------- -7. Ro -Phone--- <br /> ............-------------------- --------------------------------- <br /> --------------------------------------------------------------I------------------•----------------------- <br /> Contractor's -Name <br /> - -- - ------ ------- -------- <br /> Installation will serve: 1, Residence [Fr�Apar`fm`er_1 f House--- Commercial <br /> . - - - ---E]----Trailer-iler---Cour------------------- Phone <br /> Number of living units: _/----- ❑ <br /> Number of bedrooms --- MOW 0 Other E] <br /> I -_ Number Of baths ---k Lot size <br /> Wafer SuPPIY: Publics,- ystern' mmunify system E] pri --------- ------------------ <br /> Character of soil to a .depth of 3 feet: vafe'El Depth to Wafer Table --- ff. <br /> Sand El Gravel El Sandy Loam EJ Clay Loam E] Cla ' <br /> Previous Application Made: Yes 0 No,(P?w�Ne, y [3 Adobe 1;FHardpan Ej <br /> Construction: Yes <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: pw"00M <br /> (No septic tank or cesspool.permitted if publics' <br /> Septic Tank: Distance from nearest , 4�M ewer is available within 200 feet.) <br /> 3resf w,I t.----Distant*ry ------ is ancg fro t foundation-----. M jae rj,a I <br /> No. of compartments----------I—----- ----Size----Ai � <br /> Disposal Field: Y-1 '4_S7___Liqu d depth-------.Ma <br /> ------ <br /> Disfance-.from nearest well-----------------Distance from f - ----------------Capacity------- _ <br /> Number 0`f.lines----------------- ---------------- I 'T_jguwation--------------------Distance to nearest lot line_--.___---__- <br /> - <br /> ine--- <br /> Type of filter material-------------- . __ -.WR4r6rPeach line-------------------- -:•---_Width of french <br /> 162�� ---!7777�ePth of filter material------------_--------Total length----•--.------ <br /> Seepage Pit: Distance to - �'r 'f ' 11. ' ------------------------------------- <br /> ne es we ---- ---------------Distance from fo ' <br /> ❑ Number of pits. i i undaf ion--------------------Distance to nearest ]of J;ne <br /> ... ---------------Lining material--'--,------------ ----Size: Diameter.---------------------Depth-.- <br /> Cesspool: ......... <br /> x iL V <br /> Disfanc-e from nearest weil ------- <br /> 111 <br /> n Siz'e.-Ibiei'me' fer _-Di tance from foundation------------------ Lining material_-._--.._----_ <br /> Privy: -------------------------------Depth------_----------------------------- -------- ------Liquid Capacity- ------------------------- I <br /> Distance:from nearest well---------------------- I - ga S <br /> ---------------- <br /> ❑ <br /> Distance to nearest lot 1�ne'___41 - <br /> _-.-__-Distance from nearest building-------------------------------- <br /> -----I-- ---------------------------------------------------------------------------------------------------I------ <br /> Remodeling and/or repairing (describe)i------------------------- R <br /> ------- --------------------------------------------------------- --------------------------------- -------------- ------- <br /> ------------------------------------------------- --------------_ ---------------------------------------------------------------I-------------------------------------------I--------•---------•-------- <br /> -----------------*-------- -----------------------------------------------------------------------•---:------------------------------- <br /> --------------------------:-----------------------I----------------------------------------------------- ----------- <br /> ----------------I---------------------m------------------------------------------------------------------------------------------- ----------------------- --------------------------- <br /> --- - - - ------ ----- ---- - <br /> 1-hereby certify that I'-}leve prep6red-Ats application and that the work will be done in-accordance with San__Jo,'a_quin__Co-unty- <br /> ordinan e . State lawl and rules d regulation of the San Joaquin Local Health District. <br /> C-6 <br /> (Signed)-.1-JAA--�. <br /> -------- --- ---- -- - --- ------------------------------------------------- ------------------------------ <br /> :By:. A ------------ --------(Owner and/or Contractor) <br /> ------------ <br /> ..... ... <br /> .... ......... --------------------------------------------------------------(Title)- <br /> ------- ----------------- ---------------------------------------------- --------------- <br /> (Plot plan, showing size o�-io}.._'_ioca I system in relafion to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY_-- - <br /> - <br /> ----- <br /> ------- ------ --------- ­-------------------------------------------------------------- DATE �_4110 <br /> REVIEWED BY .1 ------ <br /> ................. ..... ------------------------------------------------DATE--------------------•- <br /> Alterations <br /> DATE <br /> BUILDING PERMIT ISSUED------------------ --------------------------------I-----------------••--------- ------------------------- --------- DATE------ <br /> Alterations and/or recommendations:-------_-....-__--__-- i <br /> ----------------------------------------------------------------------------------------------------------------------- <br /> ----------------------------- --------------­---­----- ------------------------------- ------------------------------------------ ---------------- <br /> --------------------------------11------------_------------- <br /> --------------------------------------------------------------------------- ---------------------­--------------------- ---------------------------------------------------------------- ------------------------- -------- <br /> -----­---------- ----------- ---------- ---------:------------------------ -----------------------------------------------_--------------------- -----------*--------------------------I--------- ------ <br /> ---------------------------------- ------------------------------- <br /> - --------------------------------------------------------------------------------------- -------------------------*----------------------------------- <br /> FINAL -INSPECTION-­l3Y:_i ,�-------- .5_ - Date-----.. <br /> ..... .......... --- ---------------- 9 ......... 1 r SSS ----------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street <br /> Stockton, California Lodi, California 814 North "C" Street <br /> Manteca, California Tracy, California <br /> E5-9-2M 145446 ATWOED 12'54 <br />