12421 - Laserfiche WebLink

Home Browse Search

~ - =�~ APPLICATION FOR SANITATION PERMIT Permit No. k�w�p�� C��\ --- (Complete Duplicate) Date Issued _-�j�/9��` ' Application is hereby made to the San Joaquin Local Health Dist rict for a permit to construct'and install the work herein described. This application is made in compliance with County Ordinance No, 549. JOB ADDRESS A ------7 nJ Owner's t- ---- -- ------------------ . . ... ..... ....... tPhon ----------------------- --------- Installation will serve: Residence Apartment House E] Co mercial Trailer Court E] Motel [] Other [j Number of living units: Number of bedrooms -------- ber of Xbaths n�Lof size -------Y_ Water Supply: Public system E] Community system Private Depth to Wafer Table /v)-- ft. Character of soil to a depth of 3 feet: Sand 0 Gravel �v<L0 y Loam E] Clay Loam E] Clay E] Adobe Hardpan E] Previous Application Made: Yes E] Noo New Construction: Yes V Nc�El . FHA/VA: Yes F] No TYPE OF INSTALLATION AND SPECIFICATIONS: .0, (No septic tank n,'cempoolpermitted ifpublic sewer Yoavailable within 200 feet.) ^ Sektic Ta Distance from nean,sfwell---------- ------Distance from foundation--------------------Material --._----._.----- N of compartmentsSize_ id 4spVosal Field: Distance from nearest well S.10-Distance from foundation Distance to nearest 19f jine---- ---------- KNumber of lines--- ---Length of each line------- idfh of french,_j2 J er -------- 4~"~' - 3eepoge Pit: Distance to nearest well �—'''—'''Distance from foundation--------------------Distance to nearest lot line--'—'-- [] Number ofpits----------------------Lining material----------------------- Diameter----------------------- --------------------------------- Cesspool: .----__---'Cespoo|: Di0ncn from nearest well —�—�—Distance from foundation--------------------Lining material —.—'''�------------------ El --'—''--[l Size: Diameter----._--r---Depth------------------------------------------------------Liquid C� i��_—._,.,--,.gu|,. . ^ _ _ _ - `~ Privy: Distance from nearest well �''—''''--'—''—','—''Distance from nearest building------------------------------------------ Distance to '��''--''__.'—'—U|stooco +u nearest lot kno--------------------------------------------- - ----___----. ` Rvmocle|ng and/or' re, irinn [dmscri6r) '--'-----_----_ _---- '-----''--'--''--'---'--'--------'—'''---''v`------'---'----- ----—'--------'-----'--- '----''-------'------'--------''---''---'--'--'----------------------------'---' '—''--''--'''-'—''--''—' ------------ ----------------------------------------------------------------------------------------------------------------- ------------------------------------- | hereby certify that I have prepared this application and that Ae work will be done in accordance with San Joaquin County ordinances, Sfacd*'L�ws. and rulesp regulations of the San Joaquin Local Health District. (Signmu------------ &�; ----------------0 Sys em (Plot plan, showing size of lot, lo*atio system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------------------------------------------------- ---------------------------------------- DATE_----___---_— — REVIEWED 8Y. BUILDING PERMIT '— |SSUED-'_.------_------.---- A�e,wt�nsand/*, ,wwnnnon6aMonu:---------------��—. --.-��—.-----------D—�.-T_E—_/—_m..—_--�—�--�. _—_—_�._�_—.—__~_«�._�_�_�_.__ '------------'-----'--------------'-------------'---'----'----------'------' �_��__��_��'��___��____��___��_��__��__��__��'__��__��___�_��_��_��_�� ---------'----'---------'-----------'------' ----'------'----'—'--'—' --''---''--''—''--''''' —'''—'''—''''''—'---'''''--��'''—''--'----_'�—' . . . � ��..�F|N \L INSPECTION BY:--.. � � Date------ SAN JOAQ0NLOCAL HEALTH DISTRICT 130 south American Street smoWest Oak y+=°* /oo svc°m"= otr°.* ow w"w* ''C" Street Stockton, California Lodi, California Manteca, California Tracy. California ES-9-2 w n°°/,°d 1-5/ pT.cn. _ _