12131 - Laserfiche WebLink

Home Browse Search

OR OFFICE USE: �^ 13,f j & - _:3Up-- ------------- 3n-- APPLICATION FOR-SANITATION PERMIT Permit No. -Aal..3 . ------------ ----------------------------- ------------- (Complete in Duplicate) Date issued .._?/lX`�`-iA ----------------------------------- 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 descried. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION 710 Ea B-- ��h__St.--I-------------------------------------- ---------••------------------------------------ Owner's Name------------ ••-AAA E. aMd---Martha--G---- Fen)der'------------------------------------------------- Phone--- z .... Address--------- O hl.►�t•...............•----------------------------------•---------------------------------------------------------•----------•----------------------'�, Contractor's Name-.--------Delt��---8eptle_..Tank Service_.....lce_�_.. Phone--Ao-.---�`a12 - Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑- Other ❑ Number of living units= ___-l-__ Number of bedrooms a___:_ Number of baths ___1_ Lot sizex___200 Water Supply: Public system k] Community system ❑ Private 0 Depth to Water Table 4:5___ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam❑ Clay ❑ Adobe® Hardpan ❑ Previous Application Made: (If yes,date---_---_------------) No ] New Construction: Yes In No ❑ FHA/VA: Yes ❑ No Q9 TYPE OF INSTALLATION AND SPECIFICATIONS- (No septic tank or cesspool permitted if public sewer is available within 200 feet.) {o cement—brick Septic Tank: Distance from nearest weil__5 ::_____DistanceTfrom 4�ndation__ D____.__.__-M t�ria)_________e_s ____._______________________ No. of compartments------- ?---------------Size------------&-----------`-----Liquid depth---��-----------------Capacity----$DQ-----•---- ` Disposal Field: Distance from nearest well__ _ 7__.Distance from foundation_ 10t._...._.Distance to nearest lot line____1p___- Number of lines_______-_--.---------------------Length of each line_______ -------- --Width of trench.___ -------- Type of filter material_---ir Q-Qk_____.__=Depth of filter material---------1........Total length_____._____ _------------------------ Seepage ____________'______. _Seepage Pit: Distance to nearest well----!QQt-------Distance from foundationDistance to nearest lot line____5.__P---- l._.t_oCk_-------Size: Diameter-----3-3-11 ___- ----------Depth-_.g5_----_mom° Number of pits------- -------------Lining materia Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material___.____.__:__It------------------------ \ _ ❑ Size: Diameter--------------------------------------Depth------------------------------------------------•---Liquid Capacity--------------------- --------gals. t Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_______E____:_._..___._.______._____.. [] Distance to nearest lot line------------------------------------------------•----------------------•--------- •---------------- Remodeling and/or repairing {describe):__.1'eW-_pyg�em_'for•_`Qne_ bEd Toom---hQme ............. r �. -------------------------------------------•------------------------------------ -- • ---------------------------- --- ----- -------------------------------------------------------------- ------ ___________ __________________________________________________________________________________________________________________________________________________________________________________________F___--------------- -------------------------------------------------------------------------------------------------------------__________________________________________________________________________________________________________________ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. '• (Signed) ._ a .SeR1ic---TAilk .S-ESPY Ce-.----In-c-'-s---------------------------------------- --•-----------(Owner and/or Contractor) By:------------------Pei ry_._.Wax than--------•-------------------------------------------------------------:-----(Title)--Gen.---Mgr•.---- ------- -- ----------- - ---- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc.,.can-be placed on reverse side). FOR DEPARTMENT USE ONLY l APPLICATION ACCEPTED BY---- -j0- --------------------------- DATE-----;'� ------------ 0 4 --------------------------- REVIEWEDBY-------------------------------------------------------------------------------------------------------------------------- DATE----------------•--•---------------------------------------- BUILDINGPERMIT ISSUED-------------------------=---------------------------------------------------------------------------- DATE-------------------------------------------------------------- Alterations and or recommendations:___:__.._!. ----------------- ----------_ 7b -------------------------------------------------------------------------- ------------------------------- 2- -- - ----------------------------------------------------------------------------------------------------- " -4e.6--- ------ -•-- ------------------------------------ ----- ---- --------------------------------------------------------- ----------- -•-•-----•----------------------------------------------------------------------I-------------------------------- FINAL INSPECTION BY:--- �.�L.- Date --- 2 �� SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,Californla Manteca,California Traty,California E9-9 REVI9 E0 9.59 F.P.L O.2M 6-9G h