Laserfiche WebLink
Permit No. --------- <br /> FOP, SANITATION PERMIT - <br /> APPLICATION . , .t-. Date Issued ----A/ <br /> (Complete in Dupliciatel <br /> d install the work herein described, <br /> Joaquin Local H-ealth District for a permit to construct an <br /> anon is hereby made to the San ............ <br /> e with County Ordinance Nio- 549 ----------- <br /> 0 in comptiaric ----------------------------------- <br /> I is mad ......... ---------- <br /> pp 4-44 ...... <br /> ------- I— -- ------------------------------- Phone-----------------------------•--••-. <br /> LOCA.T11 ---------- ----­-------------- - ------- --------------- ----- - <br /> &f6s,------------------- ------------ner s --------- <br /> ----------------_---- PhonX4� -0.17 <br /> ---------------jo---------- --------- -------------- <br /> ----------*--- fir ------------------ ------------------- <br /> ddress_......4. ------------ ---------------------- <br /> d?_04 -- "Ino--- Commercial 0 Trailer Court 0 Motel 0 other [3 <br /> Contractor's Name__-_ House 0 --- ------ ---------- <br /> Jence Aw Kp� s 26 ------- <br /> Resi artment of bath __/... Lot size installation will serve: bedrooms ---f-- Number . 50 ft. <br /> Number of living units'. A---- Number of be stem 1] <br /> Private [] Depth fo Water Table Adobe 4�-rl5dp.n 0 <br /> -c system 4?-�ommunity SY clay Loam 0 clay 0 <br /> Water SuPPIY' Pub" Sand [] Gravel 0 Sandy Loam 0 <br /> Character of .;1 to a depth of 3 feet- Construction: Yes 0 No <br /> No &�w Cons <br /> us Application Made: Yes <br /> ❑ <br /> Previous j <br /> 'AND SPECIFICATIONS: allable within 200 feet-) <br /> TYPE OF INSTALLATION' public sewer is available Material------------------------------------------------- <br /> (No septic tank or cesspool permitted if -------------------- <br /> well----------------Distance from foundation ----Capacity_-------------------- <br /> Sept, Distance from nearest Size---------------------------- ...Liquid depth-_.__-------- -------- <br /> N <br /> No. of..compartments-------------------------- Distance from foundation---------------•----Distance to nearest lot line----------------- <br /> --------- Width of trench----------------------------------- <br /> .- <br /> rench----------------------------------- <br /> Distance from nearest well ine------------------------ ---------------_- <br /> Isposai I Number or lines---------- <br /> ------ Length of each I ----Total length_ / <br /> I Depth of filter material__----------------- - <br /> Type of filter material------------------------- afion---.,/ -. <br /> ,_J-_�__.Distance to nearest lot line_.---- <br /> nce&�mltOurd "eto-. -- -------------------- <br /> weii0vik-------------Dista s,7 r----2? <br /> i.e. Diamete - ------ -----Dep <br /> Distance to nearest <br /> Seepage Pit Ntum8er of pits. ---------- Lining materia rn foundation-- -----------------Lining material-- ----- --------- ------------------ <br /> esf well____________----Distance fro Liquid Capacity--------------------------gals. <br /> Cesspool'. Distance ivOrn near ---------------- <br /> Size: Diameter--- ----------------------- ----------Dept h----------------------------------- Ibuilding--------------------- ...... <br /> Distance from nearest --------------- <br /> Distance from nearest well-_.." ----------------------- -------- -------- --------------*------*--------------------- <br /> Privy: ------------------------------------------------------------- <br /> Distance to nearest lot �'ine-- --------------------------------- <br /> El <br /> Remodeling and/o, repairing <br /> -------------------- <br /> -------------------­_------------------- ------------------------------------------------------------------ <br /> ------------------------------------- <br /> (describe):--------- -------- --------------------------------------------- --------------- <br /> ------------------_--------------------:1--------- ----------------- -------------- -------- ........... <br /> ----------­------------ -------------­--------­-------------------------------------------------------- <br /> ----------------------------------- <br /> -----------------------------------­------------------------- ---------------------------------------------------------------- ------------------------------ <br /> -----------------------------------------------------------------------------------------------------d--that--h-e--work will-be done in accordance with San Joaquin County <br /> I hereby certify that I have prepared this application an al Health District. <br /> ordinances, S ate laws, '.a rules regulations of the San Joaquin Lac --------------- ------- ner and/or ontradorl <br /> ------ <br /> 5i ned _ <br /> --- ----- ----- --- ---------------1�------ ----------------- ------------- . <br /> —-----------------------------------------------------------(Title)---------------------------------------------------------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, efc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY------------------ - ---------------------------*----------------------- DATE---------------_---------------------------------------- <br /> REVIEWEDBY------------"1---------------------- ----=---------- --------- ---------------------------------------------------------- DATE------------------------------------------------------------- <br /> BUILDINGPERMIT ISSUED------------------------- ------------------- -- ------------------------------------------------- DATE----------------(S ------------------------ <br /> ------------------------------------------------------I---------- ------------------- <br /> Alterafions and/or recommendations------------------ --- ------- ------------------------- <br /> -- ------------------------------------------------------------A�------------------------- <br /> --------------------------------------------------------------------- <br /> ---------------------------- -- - ----- -- ------------ ---------- - - --------- <br /> ---------------------------- - ------ ---9. <br /> ----­--------------- ---- ------- ------------------------------------------ ---------- ------------------- <br /> ---------------- -- ------------------------------------- ---------- ---------- -------------------I----------------­-------- <br /> ----- ------ -------------- ---------------- ­ ------------ ------------ ------------ ------------------------- <br /> ----------------- ------- -------------- <br /> FINAL INSPECTION 1! BY:--- ------------------------------ Date../------ ------------I-------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> Es-9-2m 145446 ATWO1710 12-54 <br />