Laserfiche WebLink
rUK uf-H E USE: — <br /> .."------------- -------------------- ---------'--------- <br /> ------ <br /> -- <br /> ----- ----------------------­----- ----- ------------- APPLICATION FOR SANITATION PERMIT Permit No. ..�s��,Q� <br /> I ------ -- ----- ---- -------- (Compfefe-in Duplicate) <br /> ' - Twi--pW­ Ez fires Y-Year From Da i Issued <br /> Date Issued .�c .-: -_�J <br /> Application is hereby made to the San Joaquin Local Healfh.District for a permit,to construct and install the work herein described. <br /> This application is made in compliance._w.ith_Counfy-19,rdinance_No..549. 1 <br /> t JOB ADDRESS AND LOC `T10N------------ 59?� 7� ��- /IA'T"RQ P <br /> Owner's Name _�-�- � a ��'.`..... ------------------ Phone. ----------•--------- <br /> r: <br /> Address---•---------------•- - . ---•-------/v--`--------- <br /> Contractor's Name------ E= --•-- <br /> j <br /> •. <br /> I--------------- ----------- ----- one--------................ <br /> ... <br /> Installation will serve: Residencee� ❑ Apartmeff--Housej Comriie'r6ial F] !Trailer Court C] Motel El Other ❑-- <br /> Number of living unitsF Number of bedrooms:... Number of baths. Lot size ...� Q9PV D --� <br /> i ---- <br /> Water Supply: Public systern,,.E�'Cl mmunity system ❑ Private ❑ Depth .to Water Table ------ - ft <br /> E�.� �, , <br /> Character of soil to a depth;of 3 feet San ,Gravel ❑ Sandy Loam ❑ !Clay Loam [❑ Clay ❑ Adobe ❑ Hardpan ❑ <br /> Previous Application Made- (If yes,date_.. ...._. J No New Construction: Yes 2311Fo ❑ FHA/VA; Yes ❑ No ®-' <br /> TYPE OF INSTALLATION AND 5PECIFICATIO— NS: r <br /> (No septic tank or cesspool permitted if public,rsewer is available within 200 feet.) vv <br /> + ./ <br /> Septic T lc: Distances from nearest well.. ." DistaO�ngJ�e from foundation- 10-.--------Material <br /> I <br /> No.: of compartments._ _-_size..T)J0-k-6--__-U uid <br /> Disposal Field: Disfanwfrom nearest well-,CM/ Distance from foundation----/L,l.........Distance to nearest lot line�j —.._.... I <br /> Nurlber;nf lines -t'.__-__ :-.--...--.-}---Length of each line...._!-t9�"-" f_-.-.N/,id'th of trench-...:' -_ re <br /> Type of filter material---.4420 Depth of filter material-.-. . <br /> �.-;--•-;---Total length--- ------2?.7---0--•--4--------•---- (X � <br /> Seepage Pit: Distance:to nearest well----x..........-------Distancefrom foundat;ion--------------------Distance to nearest lot line----------------- <br /> I <br /> ❑ Number.'Of pits-- =: Lining material---------------------- Size: Diameter---------------.......Depth----------------------- i <br /> Cesspool: Distances from nearest well-----------------Distance from foundation---- Lining material.-...."_-".... <br /> ❑ Size: Diarheter. -.,--.-"-.-- _ __. } <br /> Depth ----- -----=-------- ---------------L;gu;d Capacity---------------------- -----gals. <br /> Privy: Dista 'from nearest well- ___..._-. __._Distance from nearest buildin <br /> Distance to nearest lot line . a . - �. -9--------------------------------------- <br /> EJ ' ---- <br /> - - )- <br /> -it <br /> Remodeling and/or repairing: (describe):___...__- --.. --------- � q <br /> trs i <br /> t ----------------------------------------------------- <br /> --------------------------------- -`--------------Y--------- i <br /> - ! - . •------------�--- --------------- ----------------------------- ------------------------•--------- ------------------------- <br /> ---------- i ',i ---------------------------------------- ------------------------------------- ----------------------- -------------------- - - <br /> I hereb4ews <br /> certif •that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, -rules nd re ulati sof the San Joaquin Local Health District. <br /> �Si ned( gne),__ -____ Owner_-and/.or�Contractorl—By:--- -------- ---- - ... i7 s It t----(Title)---------- . <br /> (Plot plan, showing size ,of lot; location of system in relation to wells, buildings, Iefc., can 6e placed on reverse side). <br /> (i FOR;DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY_-. - = ) 1� <br /> DATE.------ = z <br /> �, .. ----------- t- <br /> --- j �, t <br /> . -----....... <br /> REVIEWED BY -�- ' .- ------ DATE----- - <br /> BUILDING PERMIT ISSUED-------- -- f ,. ------------ <br /> (-'- -------------- DATE--------- ------------------------------------ --------------- <br /> Altera ons ander recommendstions:.... ._'-.��_`6 ____-_106 4i'F ! f0 1! i <br /> 0"?5 .` ._. _ - ----_�_r------------::-------- <br /> .' <br /> - _--w- M <br /> -- ----- A .: w= <br /> - Lc..: <br /> cul <br /> -- -- ---- -- - ---------------- <br /> FINAL INSPECTION—B-Y . - Date-------- G_-_2-:�J--."�_2�------------------------------ <br /> f <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 S.Noxellon Ave. 300 West Oak Street 124 Sycamore Street <br /> 205 West 9th Street . <br /> Stockton,California Lodi, California Manteca,California Tracy;California <br /> E.H.9 2M 1-67 Vanguard Press vF -^ <br /> { <br />