5028 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. !-_4.r_;?J' (Complete in Duplicate) Date Issued3/ -V 5x- Aplica-lion is hereby made to the Son 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. 49. JOB ADDRESS AND �CATIO -------- ------------------------------------------------------------_ L Owner's Name-A-,09, - -------------- --- ------------------— ----------------------------- - --------------- ------------------------ Phol ---------------- Address ------- .... -- - -- ----- -------------------------------------------------- --------I------------ ------------------ Contractor's ----------- -- -- -- ------------------------------------------------- --------------- Phone ------------- Installation will serve: ResidenceApart;%e ZlHouse Ell' Commercial [-] TrAiler Court Motel El Other El 16. Number of living units``__ X- Number of bedrooms_ Number of baths Lotisize ------------------------------------------------------------ Water Supply: Public system El', &mmunify system El 11`rivat� Depth to Water,.T!able_.?�TE Character of soil to a depth of.3 fee+: 'Sand E-] Gravel Ej]r Sandy Loa m.[g Clay Loam 0 Clay Ej\ AclobAe Hardpan * . t� I t 11 _4 Previous Application Made: Yes.E] ,No. �r New Construction: Yes� N, [:] TYPE OF INSTALLATION AND SPECIFIbAflIONS.- (No septic tank or cesspool permitted 1 public sewer-is available within 200 feet.) Septic Tank: Distance from nearest W9[li__J'��_Distance from founcla'tlio`n__/. _�........Nteiial--- ------- ---------- No. of compartments---- ---------- Liquid depfh--5----- -------Capacity_ d__-___�e_ 1 f _�LL DV Field: Disf�ance from near t ell" L5 ---Distance from foundation_ Distance to nearest lot line.------ ------- \--------- Ile?------------ Number of lines------ ----------- --`-----Length------Leng-th of eKh'lineV�_/ --------.Width of trench------ ------------------ Type of filter material __-4WI4+h of length--------- ---------- -0 1 //� 11 \ ;_--- Seepage Pit; Distance 4'rhe'aresf well- Dis-rance o If 'Jr1dation__/- ---------Distance to nearest lotlin'e----------------- a-,; ------ t,a ------------Depth------ ---------- '0-rr Li_n_�n_ materia ;Kf Siz6D" Number,of pits.---/ � Vit '----Sze: - —— g Fri V Cesspool. Distance from!neare;f well fr% i foundation I----___,--------Lining material-_.________-_____.._-----!A____. El Size: Diameter------------------------------ ------- _pLh-----------\--------------------------------------Liquid Capacity- --------------------------44s. Privy: Distance from ine-ares4ke-A z -----------------------------Distance from neares+i' building------------------------------------------- ..::i kO - El Distance to nearest lot -A stk----- ------- ------ ----------- ---------------- ------ ---- --------------------------------- Remodb ling and/or, repairi rl e)l---------- -- - ---------- .,Z, .1.Z k --------------- ... I n (djz. ----------- p ---------------- ------ --------- ---1... ....... ..I----- -------------------------------------------------------- ---------------------------------------------------------- ---- ------- - tZ.,- -- ------ ---------------------------------------------------- ------ ------------------------------------------------------- Lf -------- --- - ---- -- 1. ------------I----------------------------------- ---------------------- -------- -------- -------------I------------------------------- -------------------N------------------------------ -------------------- I Hereby by certify-that I Vaye piep ed this application hnd�fhat the work will be done in accordance with San Joaquin County ordinan6s, Sfat6 laws, and rules and regulations of-fh;JS-an,Joaquin Liocal Health District. (Signed) -—-------------- 1451 ---------- ----------- ---------------------------------------------------------------e-----.(Owner and/or Contractor) By:------------------------------------------ ---------------i------------ ------------------------ --------------- ---------- --------------- (Plot plan, showing size of lot, location of system in relation to wells,'buildings, etc., can bewlga7d on reverse side)ire' A/ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY 1 1.- 1.* N --------------------------------V-53 .. I I& ------------------ ------------------- -------- DATE-----------% REVIEWEDBY-----I------------------?�--------------/_-=?-—-----—----- - ------4------4-------------------------- DATE--- -------------------------------------------------------- 'b. - ----------------------------------------------------------------------- ----------------------------------------------------------- BUILDING PERMIT ISSUE ------ DATE., S11 Alterations and/or."rec'ornmen-datio-ris------ ----------------------------------------------------------------------------------------- ----------------------------------------------------------- x }---='----- -4 1 S, ---------------------------------------------- ---------------------------- ---------------------------------------------------------------------- --------------------------------- -------------------------- -------------------Mr------------ ----------------------------------------------------------------------------------------------------------------------------------------------------- -------------------- ----------------------- -------------- --- ............----------------------- ----------------- - ------I-------------------I------------------------------------------------ --------------------- ------------I..........---------------le------------------------------- ------------------------------------------------------------------------------------------------------------------------- Ile FINAL INSPECTION BY:.-- - ---------- Date-.---- . I-----------------------------------------------------------• SAN --- ---------- SAN JOAQUIN_LOCAL HEALTH DISTRICT 130 South American Street NO West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M ; . Revised W-2100