13368 - Laserfiche WebLink

Home Browse Search

FOROFFICE USE:. ....lwt_k� ----------------- ------------ --------------------------._------_.-- APPLICATION FOR* SANITATION PERMIT Permit No. __1 / __�?..-. ------------------------ -------------------------------- (Complete in Duplicate) �! �, to ---------------------- This Permit Expires 1 Year From Date Issued Date Issued _________ __________� Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. / ^ Zzf ^0-3 'JOB ADDRESS AND LOCATION-,---------- �___1_:___Box -1$98, 3rd--house--from the end Owner's Name___GeOr_._ A11C•e -shfn u aide of Kl Av., LaR, Ca�1 'p g ------- .. __ -- ----------- ------------------------------------------ onep Address----81,-_._1}___Box 1$ 82 gZo Av. Lathrop,_-— 1st__rd.- past Frewert_ on W, side of Contractor's Name_.AP].t_ -- .�7�tiC-_T•At1k 322*Y, jI11C.- ----- ---------------------- • -•-- Phone------$..--o•....k••-9 asS Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: )---_-- Number of bedrooms ---Z_ Number of baths .!____ Lot size .._�$Cx'e------------------------------------------ Water _--_-__-•-_ ___ ___ _ ___ -Water Supply: Public system ❑ Community system ❑ Private ® Depth to Water Table 25___ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [)c Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ 1 Previous Application Made: {If yes,date____________________) No EF New Construction: Yes No ❑ FHA/VA: Yes ❑ No C TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer`is available within 200 feet.) r Septic Tank: Distance from nearest well_____5_0------Distance from foundation------J_fl __..__.Mat riai____--__..qRL'_eID-_A:4------------ No. of compartments 2------------------Size-AIX._I ,__.Liquid depth----.-- --.-.-.__.-_-Capacity____8ofl_--------- Disposal Field: Distance from nearest well------591-.--Distance from foundation____ l-pr___._ Distance to nearest lot�line-------�---�_____ Number of lines------------a,.---__-------------Length of each line---------- a.______.._Width of trench._____?11_--______________-._ Type of filter material__--7QCk---------Depth of filter material____-_ a.----------Total len gth_=______'-!Z> t � Seepage Pit: Distance to nearest-well___901----------Distance from found __ ation_ ,.1Q_-______.Distance to nearest lot line _____a_t.._. �] Number of pits----r�------------Lining material__----rOCk-----Size: Diameter--------33..".......Depth--____ �) Cesspool: Distance from nearest well------------------ foundation--------------------Lining material-------------:---____________--__-____. ❑ Size: Diameter-----------------------------------•--Depth-------:--------------------------------------------------------------------Liquid Capacity--------------------------gaIs, Privy: Distance from nearest well--------------------------------_----------------Distance from nearest building_____.____-_-___________-_.___.__..___.._. ❑ flistance to n©crest lot line y --------------------•--------- ...... Remodeling and/or repairing (describe):----11eX -sy-sleIII_---tQ..x'_Qpa,&Ce--- ld--syst em•_•_-_------- ---------------------------------------------------I--------- =------•------------------------ -------------------------------------------------•--------------------------------------------------- ------------------------ ----------- --------------------------------------------------------•----•------------------•--------------------------------------------•---------------------------------------------------- I hereby certify that I have prepared this application and that +he work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. DElta__S_eptic Tank SerV,_,i _ Ine. _ {Owner and/or Contractorl (Signed) ------------------------ By:------------P-ex'ry-- War_'khan-------------------------- -------------------------------------------------------(Title)--------G e-n --Mgr-....... ............... -- (Plo+ plan, showing size of lot, to ion of system in relation to wells, buildings, etc., can 6e placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---' i ------------------------------------------------------------- DATE- REVIEWED ATE REVIEWED BY ------- DATE - ------- y BUILDING PERMIT ISSUED --•---- --------------------------------- •---------------------------- DATE-------- { Alterations and/or recommendations-----------=---- -------------------------------------------------------•-•----------------------------•-----.-.-----------•-------- --------------------------------------------------------- ----------•----------------------•-•------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------ --------------------------------------------- -------- •---- ----- i J FINAL INSPECTION BY:------- � Date. 6 --•-------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 Wese; th Street Stockton,California Lodi,California Manteca,California Tracy,California CS-9 REWSED B-59 F.P.DD.2M 6.60