Laserfiche WebLink
FOR OFFICE USE:. <br /> I - ................ --------...,__--__-- .. <br /> ,,,,-„ __...... APPLICATION FOR SANITATION PERMIT Permit No. ..11`/_u.. <br /> -----------------........................•-...... -- (Complete in Duplicate) f � <br /> This Permit Expires 1 Year From Date Issued Date Issue <br /> zOQ^?30 ^26 <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install thew h r 'n e <br /> This appliccationris made in,�ompliance with Coun Ordin nce No. 549, <br /> JOB ADDRESS A �LppOCA/TJ�OJp�!__.G... <br /> Owner's Name..._. s/lrhr...f•/L- n -.. - _/.. .............. -......._.._... Phone...........---------------....... <br /> Address....... F-.-10w_ <br /> ..•!Q. - -- ---_ ' - - ...»........------. -------..........._ - ._._....__..........._.._..Contractor's Nama.. - .. .......- ------............. ....... Phone.......................... -.... <br /> Installation will serve: Residence 2?'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel <br /> �❑� Other ❑ <br /> Number of living units: ..__ Number of bedrooms Number of baths .:1- Lot size ._/�.y4'.^ ..--......I.-....--........... <br /> Water Supply: Public system ❑ Community system ❑ Private �epth to Water Table PW_ ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe❑ Hardpan❑ <br /> Previous Application Made: Ilf yes,date--_......:.........) No New Construction: Yes gj'Ro ❑ FHA/VA: Yes 23-�No ❑ <br /> -TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.)� <br /> n...�Y.._.......Ma erial..Lt..S� <br /> F - <br /> Ss tic Tank: Distance from nearest w .IQf._ Distancerom n t / . ...-.- <br /> .No, of com artments., ___....'.SizesX� pCe <br /> Disposal Field: Distance from neares well...,�p[.......Distance from foundation`L��r.......Distance to nearest lot line..�¢�.—......_.. <br /> ZP,`� Number of lines.......... �� Length of each Iine�Q�.....8. Width of trench`�_._.�_...................... <br /> ti Type of filter material/ .:Depth of filter metenaL/Q..-..._...._._Total length.>3iQ0..:............... <br /> _.... <br /> See It: Dil tance to nearest well._.............. .Distance from foundation...........__._...Distance to nearest lot line.............. y <br /> Numbe.*alj .... ............... <br /> r of pits .. Lining material-------................Size: .__... <br /> e: Diameter ........_.._._.Dept h....................... <br /> ........-i dry) <br /> Cesspool: :;. Distance from nearest wall-----------------Distance from foundation....................Lining material..._...._................. <br /> ......... <br /> �... F­11 .Size: Diameter----- -----------..............Depth................._...,--......... . . ....Liquid Capacity......'»................gal <br /> s. <br /> Privy: Distance from nearest well........................... Distance from-nearest building---................... <br /> ....__'..._..__... <br /> C1 Distance to nearest lot line-----------------.............. --__: ., .._...--'-............-----...... <br /> .....-`----------- 'J <br /> Remodeling and/or repairing (describe):-•---. - -......-------•------......-- <br /> b ` <br /> -..........._...-.......----...- - ...._---...........................------...............-•................---._...------- __.------......------------.............----...---.... 7 <br /> N <br /> \ , <br /> ............... <br /> I hereby certify that I have prepared this application avid that the work will be done tin-ea-cordance with San Joaquin County 7 <br /> ordinances, State laws, an rules and:regula ions.of the San Joaquin Local Health District. 1• I: <br /> ( gned)................. .... ........_......:... .... . .. ................. ---:....--------- <br /> t <br /> ....T (@ Eontrae+or) <br /> -- _ 1 <br /> By:-..........................._............................ - �/�.......-............:-(Ttle) �cz�7ZP.� '--............. ------------- (° <br /> (P{ot plan, showing size of lot, location of syste , n relation to wells, buildings, etc., can be placed on reverse side). { <br /> 3. s <br /> y =FOR DEPARTMENT USE QNLY � <br /> APPLICATION ACCEPTED BY................................. - - -----........ C- :._.DATE --- -tr -... <br /> REVIEWED'BY--.----------................................__......----------------......_..--------•----- l . DATE._z .,.. ` <br /> -==::: ._-----_----_-------- <br /> BUILDING PERMIT ISSUED_.._..................------.............. --.......... .....__ � \. -Ai4,L�..-••---- --.....----• <br /> - -, =-.:----..1 <br /> �. Altera ions and/or recommendations:...............__...r---.:......_.....__....__..._........ ....__._........_........._.........._.__..........�.Y� <br /> :f`_' <br /> ................... _.__ .r <br /> I! <br /> -- <br /> ........... 1p <br /> FINAL INSPECTION BY:.------ \ `� J Date....................................................-------------.._..------ <br /> ... , <br /> • SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> i <br /> 1601 E.Maselfen Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Sfockrea,Cclifornia lodi,California MuNeco,Colifornle Tracy,California <br /> a.v.co. <br />