13240 - Laserfiche WebLink

Home Browse Search

� � 4F0 � --------- APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued -- ------ 7 his Permit Exl2ires I Year From Date Issued 0(-1 yo-2,1 AppliAtion is hereby made to the San Joaquin Local Healfh Dist rict for a permit to construct and install the work herein described. This application is made%74nce lay Or&nce No.r549. with Co, JOB ADDRESS AND Zo A e-0 JA 1�6 IV IL Add ' � � Contractor'-s Nome--�� -'--'-___.----.-_----..-_.-___.-- Phon�- / ' . �,�/U*Gnn �U e,n�: Rox�ancm [� �pmrhnentHoo,e [] �ommon�m| P� Tr�|a, Court [] Motel ' ' /} �+�� ' ------- 'Number units': --' Number of �o�nonm, '- Nvm��, of 6�fh �� Lu+ �ba ~��i� �� . . '- - - -' - .. -.-_-�__-_--' � Water Supply: Public system []Q Community system � Private � Depth to \�� ft. � Character of m@ to a 6em� � � �� n6.� ��| � Sandy Loam � �= Loam � �|uy � ��e � Hardpan . � ' ~' . Previous Application �4a6m: Ufyes'dotu--------------------) No [] New Construction: Yes [] No E] FHA/VA. Yes [] No �] � _ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if**public sewor is available within.200 feet.) Septic Tank. D�st'ance from nearest'well----IZ9 G!Distance from foundation--------/-.O-'*--.Maferi --------/&-W�e� I IAw Disposal Field: Distance from nou,o, well-----------------Distance from f8u dution J�w -.....Distance to nearest lot line..f�. [] Nui�n6e, of knes---------- ------------------------Leno| of each line------------------------------ of french.... ------------------------------- Type -_, --'-'''-Ty6n of filter material-------------------------Depth of filter maforioL--_---.-7ot | length------------------------------------------ ° ~ ° ' � Seepage Pit; Distance to nearest well -10L0�.. ._'/� Di �ny� �tline Number pits--------- material ----- DV _ mv+nr.. Depth-------- ----------------- Cesspool: -°.---Cess000: Distance from nou,*, well----------------- from foundation--- -----------------Lining maforuL--'-''-''--''' Size: Diameter-------------------------------------- ----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nmom, well--------------------------------------------------Distance from nearest building------------------------------------------ Distance '----''-'-_'-'-'- D|stanco to nearest lot line---------------------------------------------------------------7--------_--------- ------------------------------------------------------ , Remodeling and/or re, ��g �'-'�'-'''-''-----_-__-',' ---------------------------------------------------------------- -------------- -------------------------'------'-------'---------��''^��_,��'��'��' - � . � -------------------------------------------------- - I hereby certify that I ha'ye po6pared this ��plicafion and thaf'fh-e'work will be done in accordance with San Joaquin County ordinances, State;la7 andd rules, d regulations of the Siiiin Joaquin Local Health District. le A. BF.___--_.-_.____-_._'-_----__-__.---____.---._(Tifle)._-------- -------------------^-__ (Plot plan, showing size of lot location of system in relation to walls, etc., can be placed on reverse side). � V / FOR DEPARTMENT USE ONLY ' . � ",,^.C"..".` ACCEPTED B.--.-~"` _ .'.^====�'" -------_-__-_' °".�_-.��.�V".-"��._.__-' � REY|E�/BD 8Y''''__'----''-'''-''-��.__'--'''-�'-'-''''--_-_''-_'-' DATE------------------------------------------------------------ BUILDING PERMIT ISSUED-------------------------------------------------------------- -------------------------------------- DATE------------------------------______ / ' r/~ ' ~1 --------' ---�7T�r- ___________________________________ � RN�L�|N5PE�T|DN BY Date--- 4r ^^ '�.� ~`_~''-''----_-' '''~ ~~^ -�~^ -''-'''-'------' � SAN J�AQU|N LOCAL HEALTH O/5TR|C7 � 130 South American Street ywwWest Oak Street � 12«Sycamore Street uoaWest 9th Street Stockton,California Lodi,California Manteca,California Tracy,California � ""°.EV."",°.°°"~"=2" 6.60 ' �