13142 - Laserfiche WebLink

Home Browse Search

i-UK UFFICE USE; ------- -__-__ APPLICATION FOR SANITATION PERMIT Permit No. ..... 1.�,�..1_ --- -- -------------------------------------------------- (Complete in Duplicate) This Permit Ex ices 1 Year From Dale Issued Date Issued ------V14 f Application is hereby made to the Sari Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No, 549. JOB ADDRESS AND LOCATION.{------••--- ,-$ RO�3ex' �Qxi3___ a_cktan,.___Gaff ---------------•--- Owner's Name-----------A272 __3.iL .-r� ' ' .. 0;3a_• _ h ._. Addess------------------Abbpe-__ ----- ----------- P on0110,-..3m5811...--- I Contractor's Name------ -_____Ael�$=- �_ •----------------------------------------------------------------------I------------------------ Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _� ,Number of bedrooms ._-_Z_ Number of baths _-1___ Lot size _6Q.___.X__ -P—G!..._-..•______________________ Water Supply: Public system 9) Community system ❑ Private ❑ Depth to Water Table 35-1 ft. i Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay [j Adobef] Hardpan ❑ Previous Application Made: (If yes,d ate----..___.._.,-----I No ® New Construction: Yes IN No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if.public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_________________Distance from foundation--------------------Material-__._.__-__._n__------------------------------- I .______ ' ---•----------------- X S(;( lg No. of compartments Size. -----=---Liquid depth---•------------ Disposall Field: Distance from nearest well..__--.__.-_____{Distance from foundation--------------------Distance to nearest lot line_____.___________ ! ExIS'tnl Number of lines-_--------- :-----Length of each line------------------------------Width of trench.------------- - ------ �------------ � Type of filter material-------------------------Depth of filter material,-----------------__--.Total length----------_---------•------------_--____ Seepage Pit: Distance to nearest well _--None------Distance from foundation---------101__.6istance to nearest lot® line_�--X■------- t -•- tf Depth I ------Number of pits_-:.___1_.___ rr: ______Lining aterial__.ROC�___--__.Size: Diameter_____ P o, 'Cesspool: Distance from nearest well______________._Distance from foundation-------------------_Lining material-------------------------- ------ c'�. ❑ Size: Diameter---- --------------------------------Depth---------------------------•------------------------Liquid Capacity------------ gals. Privy Distance from nearest well---------------.---------------------------------Distance from nearest building I ❑ Dis#ante to nearest lot _________________ �{ Remodeling and/or repairing (describe):---Aadlnz---Filter7bb%l___#c0__ q t-e ----_--------------------------------------- --------------------------------------------•-----_-- ------------------------•----•-•------ ------•------------------------------- ---------------------•---------------------------------------------------------------------------------------------------I-----------------------:------- - I hereby certify that l 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. i sl Delta Inc. (Signed) -- ---------------+------------------ -------------------- ----------.(Owner and/or Contractor) Br Perr ..Warthan---------- --- --------(Title)---.-Gen..._Mgr.:------------- - ----- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--J-.'-I . -'-. 7 J S" -------------- ------------------------------------------ DATE--- ------------r� l 1 REVIEWED BY ---- - - •--- DATE-------- -- - --- ------------- ---------------•----------------•- BUILDING PERMIT ISSUED-------------- i -- _--•---------------------------------------------------------•-------- -- - ------. DATE-------•---•------------------------------------------------- - ; aerations and/or recommendations:-:____._-_._-_: -� - . . � --------------------------------------------- ----------------- ----------------- - FINAL INSPECTION BY:_,; .t.--e_._- z J Date-----------s rZ ✓ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California. E9.9 gEVIBEo a-59 i,A.0 O.2M 6.613