Laserfiche WebLink
.- <br /> �;kOR OF�ik2E USE; <br /> ------------------------------- <br /> ...... ----------------- -------------- APPLICATION FOR SANITATION PERMIT <br /> --- ----- ------------------- --------------------------- (Complete in Duplicate) Date Issued <br /> --------------------------------------------------------- This Permit Expires I Year From Date Issued <br /> .3 C,(9 <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the iAerein described. <br /> This application is .made ' compliance with County Ordinance No 549 <br /> ........... <br /> T <br /> JOB ADDRESS AN YLCill Z6__ # yowwNc <br /> Owner's Name.......----- EAF Pj:5 P/q�---------------------•-- - . ...........---------------------------- P h o n eTR:��3 433 J <br /> Address--........go. j <br /> .................... <br /> A110; ----�5T-------------MANT ...... ........-•--.................. <br /> Contractor's Name..MANTIEI:.�ft...... B\1 I c A t�-j <br /> . r ---------- Phone--.. <br /> ................................... <br /> ---------------------------------------------------- ... <br /> ;., 01 �'ou�rt []—1 T <br /> Installation will serve: Residence M," 4artmen+ House ❑ Commercial E] Traileir1,CMofel'[3 Other E] <br /> Number of living units: :...... Number of bedrooms 3... Number of baths Lo'ti_siie�7X`5 100- ............. <br /> Water Supply: Public system rj__Z2o_mhiunifF_systerh-,,E] Private 03/Depth to Water Table--,5- ft. <br /> Character of soil to depth of 3 feet: Sand 0"Gravelr] Sandy Loam L] Clay Loam E] ClayE] ..Adobe C] Hardpano <br /> Previous Application Made: (if yes,cicitq�___________________) No Z3---New Construction. Yes 9?-1�o El FHA/VA: Yes'�No F1 <br /> `TYPE'OFINSTALLkTIOWAND SPECIFICATIONS: <br /> septic tank orcesspoolP_eir��ftiid­if p-66fic—sewer 1i­available_within 200 feet.) <br /> Septic nk- Distance from nearest well---5- _.Distance from foundation----A9........Material__649/v IE T,F___ <br /> .......................... <br /> No. of compartments_____ 7-_--..___--_Size.------------ __-Liquid depth_..._1j "- ------Capacjty._Z2-.C�P... <br /> / j�-- <br /> Disposal Field: Distance from nearest _ell.__�_ ..--Distance from founclation,_ ......Distance to nearest lot line_�=............ <br /> 231" Number of lines ...Length of each ----------Width of french...... <br /> ---------- -- .............. <br /> Type of filter material-_. CK___Depth of filter materiaI:77M_'!%---T6i�r length-----------Z0.0-------------------- <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation---- ,_Zi tance to nearest lot line---------------- <br /> El Number of pits--r-----------•------Lining material-----------------------Size: Diameter-------------------_--Depth--------------------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation------------_------Uning material..--___________________._._...__._.__ � <br /> ❑ Size: <br /> aterial------------------------------------- <br /> Size: ----------Depth-__--- -----------------------!--Liquid Capacity--_------------------------gals. <br /> Privy: Distance from nearest well----- - ---------------- ---------N-------------Distance from nearest building------------------------------------------ <br /> ❑ Distance to nearest lot ----------- --------------------- i......-------------­------ <br /> Remodeling and/or repairing (describe)_________________ -- .......... --------------------------------------------------- <br /> ................................. -------------------11_ - 4 1 <br /> - -------------------------------------------------------------------------------------------------- -------------------------------------------------------- <br /> ---------------------------------------------------------------i------------------------------•­-------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------- --------------�­,4......... ---------------------------------------------------------------------------- ...........I-------------------------•--------•-••--•---------------- <br /> I hereb ify f f I hav%-prepared`- his applicaflon�-and-that the-worV'will be done in accordance with San Joaquin County <br /> C <br /> t n of I <br /> ordinancef e lam and rules red 4 tions of file San Joaquin Local Health District. <br /> J,Z4" <br /> (Signed)---- ----- - ---------- •------------------------------------------------------•- -•-----•• (Owner and/or Contractor) <br /> --- <br /> BY ------------------------- - ----- ---- <br /> - - ----------- -- <br /> ---- ----------- ­ <br /> --- -------- <br /> (Plot plan, showing size of lot, location of system in relation to wFills,L buildings, efc,can be,*�Placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------T--_R5-0----------------------------------------------------------------------- DATE-------- <br /> REVIEWEDBY------------------------_---------------------------------------------------------------------------------------------------- DATE--------------------------------------------------- <br /> BUILDINGPERMIT ISSUED--------------------------------------------------------------------------------------------- ... DATE------------------------------------------------------------- <br /> Alterations-and/dr,F6edrrinn6Kcd&ticihs=. 7­ <br /> ------------------------- ------------------------------------------------- -------_---- <br /> ---------------------------------------------------------------------I---------------------------------------------------- <br /> --------------- <br /> — ------ --- ------------------------------------------------------- <br /> --------------------------------------------------------------- --------------------------------------------------= =------------------•-- -•--.......-•••------••-----••---•----•--------....---••--------•--- <br /> ­­ ---- <br /> ................................. <br /> _ -- -------------- ........ --- ------ ------ ------------------------------------------------------------------------------------------------ <br /> -7 <br /> A <br /> .......... <br /> - -- -- ------------ <br /> ----------- <br /> -------------------------------------- -- --- ---•---------- - --- - ---- ----- ------- ---- - -- ----- -- ------------- ------------------------------- <br /> I---- --- ------------ --------------- _- --------- <br /> FINAL INSPECTION-W4. ---------. -Date:.--._--:910 <br /> 4; SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak$?rest 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> EO 9 REVISED 8-59 RM 5-61 ATLAS <br />