Laserfiche WebLink
FOR OFFICE USE: <br /> At.,.r-ICATION FOR SANITATION PEI.,.AT Permit No. <br /> ---- .................................... (Complete in Duplicate) Date Issued <br /> -----This Permit-Expires 1 Year From Date Issued <br /> Application is hereby made to the Sen Joaquin Local Heal h Districtior a germ.toi onstruc+ aro install the work herein described. <br /> This application is made in compliance with ......... <br /> �unty Or i a c�o. 549 t J <br /> - ,..ten-- pTfiRoP <br /> JOB ADDRESS AND LOCATION <br /> -�j- .. . =- R -T— b ' S -x?' •`• •`.:.'.V Pte ........ _ - - <br /> Owner's Name......---- - --=•----•-- --tJ1 ...... --...--•- ------------ Phone......._......_•-•- <br /> Address.--.1-5 .,q_l..........j._� TJQ ------..-_.-•.......................---------.-- CYQ. ----- <br /> . <br /> Contractors Name.....--Q N..V-7_9_'----•-----•-------•-•...............--------.._.... ......-----_...._....... Phone---._-..._........ <br /> :. -- <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial Trailiiller C t rt ❑ ^^Motel ❑ Other ❑ R� <br /> Number of living units: _.--.. Number of bedrooms= Number of the;7LT Lot!size ..../pp7GR �—a ...---_----_._.-.- <br /> Water Supply: Public system ❑ Community system ❑ Private O/De +h To Water }able ...!1.. ft. <br /> Character of:isoil two a depth of 3 feet: Sand (�Grevel ❑ So dy Loam Clay Loam l ❑ Clay ❑ Adobe❑ Hardpan ❑ <br /> Previous AppTic``}}tiorLMade: (If yes;date--_----..---..---) No New Cons ruction: Yes �No ❑ FHA/VA: Yes ❑ No <br /> TYPE OF 1NSTALb4TIOR-A SPEQFICATIONS: <br /> (N6 septic tank or ce rmi d if publ're ewer is available w•�ie mieaLj�r <br /> Se tic T nk: Distance from nearesst-Wel DistancesfAndation.---fQ.........Maa+erial_15toW OD-„---__-__". <br /> p� No. of compartments--------- ------------- Siz _.— ..__X .Liquid depth....:ry —------Capacity...I 00 - <br /> Disposal Field: Risfaoce from nearest well----6Q.... to m foundation .._�10......Distance to nearest lot line,: - <br /> Number of lines.........../...--...............Le of each line..-.---. ... r, Width of trench.-....jj =..--...._... <br /> Type of filter material..RQ_G,�'(.....Depth of filter material...._1�-....-...Total length_..........C2 .....:-_....--_._-. <br /> Seepage Pit: Distance to nearest well......................Distance from foundation....................Distance to nearest lot line....... <br /> ❑ -Plumber of pits......................Lining material......._..-..._..-....Size: Diameter................. Depth--------------_----__..._.. <br /> Cesspool: Distance from nearest well.................Distance from foundation....................Lining material---------.................. <br /> ...__— <br /> ❑ Size: Diameter.---------------------------------Depth----------------------_-----__..................Liqu' `Capacity...__......._..........—gals. <br /> Privy: Distance from nearest well------------------------------------------------Distance from nearest�ullding..................................._.... <br /> ❑. -O)stan�re o nepSest:lE+lll�---.....©-0: _-.------'-----.. -.__ <br /> i <br /> Remodeling and/or repairing (describe):--- '----'--------------------.-----........... -..........'------•........'-------::----- -----••--•---- -'-- <br /> ----....................--------................................-- -- <br /> ...............................----------------..............----------------------------------------------------------------------........ ............ ____---......................................... <br /> I hereby certify that 1 have prepared this application and thaf the work will be done in accordance with San Joaquin County <br /> ordinances, State lays, and rules and regal tons f the San Joaquin Local Health District. <br /> (Signed)... <br /> 16(.O. ,0.ff------- .----------- .........................(Owner and/or Contractor) <br /> :•' , T <br /> (Plot plan, showing sae of lot, location of system in relation to wells,.buildings, etc., can be placed on reverse side). <br /> r <br /> - pp FOR DEPARTMENT USE ONLY f <br /> APPLICATION ACCEPTED BY__.....l--r i.11'- - -----------------------•-----•--•--------............. DATE....... <br /> REVIEWED BY - - - - ------.....- ---------- -- - -... DATE-..... - ..........................................- <br /> BUILDING PERMIT ISSUED.... _ .-�i�1 6€?tTLC__rA_A S. - r ....... DATE..............................................." d - <br /> Aherations and/or recommendations:_OA'----..--WITH l.1=x71`�1lTL.Qf\1.....AF...ovai =:'�._ ep C....L...--.. <br /> ----------....................... ----...... .-�a.-6 -------- --------,� srA ..... -.................-.......... <br /> - - N • -...... t?cKFc 4`&-..-`` .._: j?..OKE----------4A..----•-.&C. . ---... ?----} ......................... <br /> ....... ....... --_ S'= �a/tp : .N --Ods=..............�?iY.:...------ - --- <br /> ------------------t.........-..................-.. -- — ------------ -- --.. .... .... .--- -q-- -------------------------­ <br /> ------ - -------- ....-•------- /�nL- -- --'-----•------ ------------------- <br /> /+r'kvi Date._..._!'_149 �.. . ..... ........... --------- <br /> HNAL INSPEC . . -- 7 - ....... . -- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 Soath Amvican Street 300 Wnt Oak S,ree1 124 Sycamore Street 205 Wet 91h Street <br /> Stockton, California Lodi,California Manteco, California Tracy,California <br /> ES 9 REVISED e•59 21A 5.62 ATLAS <br />