Laserfiche WebLink
FOR OF.F.ICE USE: <br /> --------------I---------- ------- ------------------ <br /> -------------------------- --------------_ _____________ APPLICATION FOR SANITATION PERMIT Permit No. <br /> - ----- ------ -- ------ ---------------•------- --------- (Complete-in Duplicate) Date Issued _5=_ ��76 <br /> d This Permit Expires 1 Year From Date Issued <br /> -------------- - -- ---- ------------------------------- <br /> Application.is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. /"-rC)4- <br /> 2-o r-zoo ?r-2_ <br /> JOB ADDRESS AND L CATION.4,- AZO <br /> Owner's Name-_____-SDVr_11-----SOW-----1 _Q !-1.4 1KKk_6AT_16.W I$7R i <br /> Address---- <br /> - ----------------------------------------------------------------------------- <br /> Contractor's Name-----7' ......;70,9,7- -- ------------------------­------- -- ----------------- Phone4? <br /> . ............... <br /> ❑ Apartment House E] Commercial C] Trailer Court E] Motel E3 Other <br /> Installation will serve: Residence/ <br /> ce <br /> Number of living units: -- ----- Number of bedrooms ------ - Number of baths—,----- Lot size --------------------- <br /> Water Supply- Public system E] Community system El Private (Depth to Water Table ft <br /> Character of soil to a depth of 3 feet- Sand ffr"Gravel [-] Sandy Loam E] Clay Loam [] Clay El Adobe E] Hardpan F-1 <br /> Previous Application Made: (If yes,date- ..------- ------- ) No Er`*'�New Construction: Yes �o El FHA/VA: Yes FI No ❑ <br /> N TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> No:ie—pfic fan k-or-Icessirooi-per mi�iffed-4- ublic�se�%46f-ii�ay-a'ila'61e—wif��in 2-66'f- <br /> _,p eet.-) <br /> Septic T _V: Distance from nearest well__-_ Distance from foundation-- _10_*......Material <br /> of 'o I . I <br /> No. mpartments......�Z_..........--Size-/,4X,- P:X5 -----Liquid depth----- /-20.V-------- <br /> --------Capacity-- <br /> Ii Disposal Fibld: Distance from nearest well -.50.f....Distance from foundation-10.-----------Distance to nearest lot line__2;�7------- <br /> Number of �ines.---------I----------------------Length of each line_ ----7E�-`------------Width of trench._.__. ------------ <br /> Type of filter maferial.-R005........Depth of filter material__..._.d -,______..Total length__-_ -_.____76_____________________ <br /> Seepage Pit: Distance to nearest well.-.--.- --------- ---Distance from foundation--------------------Distance to nearest lot line----------------- <br /> El Number of pits--- ------------------Lining material--------------.------. Size: Diameter---------------_ ----Depth------------------------- - <br /> Cesspool: <br /> epth------------------------- -Cesspool: Distance from nearest well ________________Distance from foundation--- ----------- --LWnq material_____....._._..__--- i <br /> ;xi ❑ Size: <br /> aterial-------------------- <br /> Size: Diameter- -------- - ... .... Depth----------------------------------- ------- --__Uquid Capacity_ -------------------- ----gals. <br /> Privy: Distance from nearest well-------- ...........................__...._Distance from nearest building------------- --------------------------- <br /> N <br /> El Distance to nearest lot line --- --------- •-------- ---------------------------------------- <br /> Remodeling and/or repairing. (describe):------ ------------ <br /> ------------------ <br /> ------------------•--------------------------------------- ----------------•--------------------------------- ------------------- ----------------------- -------------------------------------------------------- --- <br /> --------------------------------------- ----------------------------------------------------------------------------------------------------------------*-------------------------------------------------------------------- <br /> --------------- ____ ---------- -------------:f- ------------------------------------I----------------------------------------------------------------------------------------------------------------;...........­_ I <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)----- --------:----------------- ---------------------------------- <br /> location <br /> f _�r arid/or Contractor) <br /> By:......... -----------------------'-----_------(Title)- <br /> ion of em in r <br /> If <br /> (Plot plan, shov4ng size of lot, oca I ion +o�. Als, buildings, etc.,.can be placed on reverse side). <br /> i in relation <br /> FOR DEFIARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY_____7T__R,.0.,1----------- ----------------- ----------------- <br /> ----------------------- -------------- DATE--------y-- <br /> REVIEWEDBY---------------------------------------- -_------ -------------------------------------------- -- -------------------------- DATE----------- <br /> ,. <br /> BUILDING <br /> ATE-----------BUILDING PERMIT ISSUED.------- -- ------- ---------------------------------------------------------- ---------------------- DATE---- -------------------------------------------- <br /> ----------- <br /> Es Alterations and/or recommendations--------------------------- ------- ----- ----------- --------------------- ----------------------- ------------------------------------------------------------- <br /> ------------------------------------------------------------------------- -- -- - ------------------------------------------------------- ---------------------------------------c--------------------------------------- <br /> -------------------------------- ----------------- ------------------------------------------------ ------------------ ------------------------ ------------------------------------------------ <br /> ------------ -------------- -------------------------- ---------------------------------------------­_­--------------- <br /> -------I——----- --- -------------- <br /> -- --------------- .......... ...... ...... --- ------ <br /> f <br /> ----- - ----- - -------------------------- - - ------------------------- ----------------------------------- ---- --- ----------------- <br /> FINAL INSP`E?_ 19.N <br /> 13�--- - --- -- ---------- ----- --- - Date..- - ----- ......7-­­. .......... <br /> SAN JOA$UIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street <br /> 205 West 9th Street <br /> S29Ckt*nr California Lodi, California Manteca,California Tracy,California <br /> E.M.9 2M 1-67 Vanguird Press <br />