21074 - Laserfiche WebLink

Home Browse Search

t FOR OFFICE USE: 7= �- --------- ---------j�------ //�� . .. 'I APPLICATION FOR- SANITATION PERMIT Permit Na. f. "7 ----------------------------------------- (Complete in Duplicate) Date Issued --------------------------- ----,lC"" This Permit Expires 1 Year From Date Issued District for permit to construct and install the work herein described. Application is hereby made to the San Joaquin Local Health This application is made in c!mpliance with County Ordinance No. 549. JOB ADDRESS AND LOCATkON....T- � / /S fill ..,_ Owner's Name---- L ` 1 .l..�fl - 1'.�-------- -------------- ------------------ Phone". -------------------- ------------- - �---- 1Address___ =T -----� --- ----- 1.1 �� ---- --•-- I Q G. Phone-- " ---- Con'fract�ir=``s�+r'Na-me�s.�'_..N--��l�.��.�----�-�---��-s�''�--� /f�... - Phone_ will serve: Resid`nce jo Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ 'K 11 ts�• o,, urRber�of�bedrooms _-. Number of baths Lot size ----- .. Water Supply; Publics stem ❑ Communh k.ystem P�ivateq.[] Depth to Wafer Table PP Y� Y �. •E. % . 'Mit,«'.WIN r, �X N ' Character�of-soil=+o-a-depth-of-•3�feet:�--Sand-S.Gravel-O�Sor�dy Looaam,Ll .tClay#Loam_© Cay []„�Adobe_�,,FHardpan ❑ s New C$nstrucfion. Yes ❑ No 1❑ FHA/VA: Yes ❑ No ❑ Previous Application ade::� (if yes,date_._....---,-- 1 No ❑ TYPE OF INSTALL.TI16N AND SPECIFICATIONS: i (No septic tank,or cesspool permitted if public sewer is available within 041-A)) - a. undat gn-----------�-&Material---------------------------------------- ------- No of ` ----Li °u$d-�-`de thA-------I-----------.Capacity------------------ -t- Septic Tank:; istance from nearest well.... ............Distance from o r ❑ * ompartments_-_---jl' "� " D stance from fo q p'' ndation....-.-.. e,;- Disposal Field"a !stance fro m nearest well....----_.- ��/�} -.-.._.Distance to nearest lot line-AV, II it �Ll-.-..._...-- �` Widts of trench.----- ;� I- umbers of lines--.._-."______ " -*-� enl t,h, of each line...__-. �� IA ype of filter material._-. j�l-Depth of filter material notal length.-_ -..." _--....__t... .. op I T� it bIs-Isto nearest lot line. � fw- Seepage Pit: �' Ditanco�nearest well-.... �--Distance fr fo ndation Number of pits. g -Size: Diameter...-- -� Depth : . .------Linin material..: to k I� - 11-1--- )m {" Cess ool: Dance from nearest --Distance frf undation-------------_.._ Linin matersal.. ___--.=r p a * Qiameter.-- Depth. ---------------- --------- Liquid Capauty.._ `- g�Is. ❑ Size.: lA _-"Distance from nearest building.____.-..___. -- ---.- I Privy: Disfance from nearest well'..-.___.............. [ i. h yy ❑ .Distance to nearest lot Ii ----------------------- -----q------ --------- --- ------- -- # . �. f Remodeling and/6' airing describe): " r II - ----------------------- ------------- -------------------------------------- ----------------------- ----- F I hereby certify that I have prepared this application and that the work will be done in accordance with Sari Joaqu n County ordinances, Sta+e lawsO and rules and regula#i ins of the San Joaquin Local Health District. I St ned % "� ---- (Signed)---- -------- --- =---- -- {Ow erVn , ontras or) [ 9 )--- ` ------ .' _ ic_ [T fie ` .- -- By:--------- ) g ` `° 'etton to wells buildings,,etc scan beTplaced�on reverse side) I [Plot plan. showing size of lot oca+ion of system in rel �� y, y «� I _ t "" .., , FOR DEPARTMENT USE ONLY ' ��q��- DATE---- I APPLICATION AGCEPTED,BY-,-.-.__.rte---__-_��-_ � --------- --- i ---------------------- - A. ------ DATE----.,------------------------------------------•----------- BUILDING PERMIT ISSUE' -----------------------------� ------ -—- ----------------- DATE. t REVIEWED BY. -.-.- -- .-- J- Alterations and/or recom endations:----------------- ----------- J----------- ----"--------------------------------------------� ------------- ---------------------------------------------------- ---------------------- ---------------------------------------- -- ------- -- ............... .......... *..._I ,eP9IF 71.rtrM �: .F..r.+x�. �'.�t.-..1�="`r.___:.:n+er,retie.__.f :...__ .-..-..--.-.-_-.....-_---.-.---..__-.-_----,.-...._• { ................-----------_-_------------------------- . . I //�/� - - Date---------- ---------- � � FINAL INSPECTION BY:"."---- - -- -- ---------- -- �-- ----- --" - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Are. 300 West Oak Street 124 Sycamore Street 205 West 9th Street i Lodi,California Manteca, California Tracy,California Stockton,California F.P.M3.