Laserfiche WebLink
FOR OFFICE USE; <br /> ................. /Z.-o..... - APPLICATION FOR SANITATION PERMIT Permit No. .,aaa'.Z:r� <br /> ...................... ............ ............... <br /> . (Complete in Duplicate) Date Issued - ' <br /> .. Ar <br /> ........... .... .71.......... <br /> `_7 <br /> This Permit Expires I Year From Date Issued <br /> ...................... <br /> �, .... ............ ......... San Joaquin Local Health District for a permit to construct and install the work herein de;cr:ibed. <br /> Application is hereby made to the' 49. —1&0_06 <br /> This application.is mode in compliance with County Ordinance No. E 7P#O <br /> 4.2jaOr- <br /> . .......... <br /> JOB ADDRESS AND LOCATIO� .... --- Phone......._.-......................... <br /> Owner's Name... JOAN...... <br /> d -----........... <br /> ....... ........ ........................ <br /> ------ ................... ............. <br /> ........... <br /> _4 <br /> 1, ................................................ <br /> ....lit *. ............. <br /> Address..... -"2 . .. .. Phone........----------------......... <br /> Contractor's Name------A <br /> T <br /> ... .. <br /> Installation will serve: Residence g?""Apartment House 171 <br /> 5.. <br /> Number of living units: _/_ Number of bedrooms .VCommercial E] Trailer Court 0 motel 0' Other [I <br /> . Number of baths ... Lot size ----_-------------- <br /> .1 <br /> Waterl' 2 <br /> Supply: Public system 0 Community system 0 Private gqI&Ipth to Water Table .7.. f+. <br /> Clay Loam [I Clay C] Adobe 0 Hardpan 0 <br /> Chara4ar of sail to a depth of 3 feet: Sand[] Gravel 0 Sandy Loam y!rl 0 <br /> Previous Application Made: (if yes,date....... ........) NoUR" New Construc+ion: Yes V;r� FHA/VA;Yes 29�No 0 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> permitted if public ser is available within 200 feet.) <br /> (No septic tank or cesspo-ol i ewm foundation... . ........materiaI_e�Ae:fxe_--1...... <br /> Distance frominearest wall-I <br /> ..AM...Distance fr <br /> Septic Tank: ----"A ,?.Liquid depth...-----------_Capacity. <br /> No. of compartments...A---------- ----------- <br /> ILS <br /> Disposal Field: Distance from nearest welIX.P.10. Distance from foundation../..P.........,Distance to nearest lot)ine...Z&..... j <br /> i of trench---1Z.......sil­ <br /> Number of in %Y. Length of each I!neZ"_..'_.Z.A9.._W!c10 .............. <br /> 1, as....... .1- .- ---- epth of filter material...,w�?49.._Total Iength.,._:FZA................... <br /> Type of filter material�l <br /> Seepage Fit: Distance to nearest well......................Distance from foundation..................Distance to nearest lot line.............._- <br /> ' <br /> ine.............. <br /> Number of Pits_............__----Lining material......._------------Size: Diameter.._..................._..............Depth_.............................. <br /> Imaterial................. ............ <br /> Cesspool: Distance from nearest well.................Distance from foundation..................Lining <br /> 0 ........... ...........gals. <br /> • <br /> Size: Diamefe'tr_....------__--------..........:Depth......... I......................._... Liquid t Capacity <br /> 171 it nearest well...............................................-Distance from nearest.6uilding_...................................... <br /> Privy: Distance from <br /> Distance to nearest lot line ....... ......................... <br /> I i. . .. - ....:...:.....I...................... ----- <br /> Remodeling and/or repairing ( pscribe):...—A . ................._..................... <br /> 0 1 L ...............j L....... ....................................................... <br /> .................... ..... ......_V... <br /> 'I .......................... <br /> ........... ........................._..............._A__ <br /> ..........1-........................I——.................... �*.. I ­..................................................I................................... <br /> A.............................I.................... ........_........ ...........­­.................. <br /> I I hereby certify that I have'prepared +hit applicaiion and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, andel <br /> nd rulesiand regulations of Ali San Joaquin Local Health District. <br /> t — I I fl <br /> -maeg-and,40f Contractorl <br /> (Signed)---.. -----..4. <br /> tr <br /> --;�----------- --------.............. -— - ------------ <br /> ..............................I.............. ......�; ��i. - <br /> By. <br /> (Plot plan, showing sirs of lot, locatioA of systomrelation to wells, buildings. etc., can be placed on reverse side). <br /> i <br /> V 1,F011 DEPARTMENT USE ONLY <br /> .................... DATE... ........................... <br /> A-PP,LICATION ACCEPTED ..... .......... ..................................I... .......... <br /> ......... DATE.-.................. --......-.....---------- -------- ----- <br /> REViEWED By.................................... .... ....... TE..... . ... .......... ............. <br /> BUDDING PERMIT ISSUE _­........I.......1----------•-•---------•. <br /> *.............. ........................ DA ----------I ... <br /> 'ions and/or recommendations. .....A.......I <br /> Alterations and/or -...........................................-----------• <br /> ----­----------------------------------------------------------------- <br /> ................... <br /> ....................... <br /> ....................................................... <br /> .....................................................I................._...... ......................................................­...............­­7------- <br /> ............... ........................I................................................ <br /> ............................................. <br /> ..................._............_....-•---_.. ....................­....................... ........ ............... <br /> ..............................­­­................................­....... ................. ........ .............. ............... <br /> ............................. ........................ <br /> FINAL INSPECTION- BY;...6�� ..................... Date...... <br /> • SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 1.Ho"Iton Ave. 300 Woo Oak WOO 124 s Street 205 W.0 9th sheat <br /> stamen,California L*44 California <br />