Laserfiche WebLink
FORFFICE USE: <br /> --------------------- ----------------------- j — wflr <br /> --- ---------- <br /> -------------- ---- --------------------- APPLICATION FOR-.SANITATION PERMIT Permit No. .-,/ 4 <br /> Compete in�uplicete) d <br /> I This Permit Ex, i. S 1 ,bear From Date Issued Date Issued . _ / .`7� <br /> Application is hereby made to the San Joaquin Local`HeaA��`Clistrict for a permit to construct and install the work b=oin described. <br /> This application is made in compliance with County Ordiiid`nce No. 549. <br /> JOB ADDRESS-ALOCATIONe <br /> CA -T ....... -------- <br /> Owner's Name... ------- D- -----. Phone........................... <br /> - <br /> Address---------13T ' . .._~ AZA ----------- <br /> ---------------- <br /> Contractor's Name_0AK•M4jF___ir'QK4%R, .rte..- pl jr <br /> J <br /> -------------------•- Phone <br /> Installation will serve: Residence e Apa,tm-nt House [:] Commercial 11T�ler Court ❑ Motel ❑ Other ❑ A <br /> Number of livingunits: j----_ Numbe of bedrooms i ~ <br /> _ Number of baths! Lot size ---------------------- ^� <br /> Water Supply: Publics stem t <br /> y ❑ Community system ❑ Private [Depth To Wafer Table 5 ft. Q I <br /> I , J <br /> Character of soil to a depth of 3�feet:- 5d'❑Gravel"❑�""sandy Loam ❑ CIO Loam lay [j Adobe❑ Hardpan <br /> Previous Application Made: ;If y s,dale NSA El New ConstructioP. Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPEC•IIiIG,�T�O,NS:,,NI <br /> (No septic tank or cesspo(,l permitted if public sewer is available within 2f0 eet.) <br /> Septic Tank: Distance <br /> from -• from foundatio' <br /> IV <br /> .MateriaL���j][r'1/C�CJ�•••_-------•--. <br /> of compartments-------.�' -------------Si �' - -- -----Liquid depth__.---- ---------._Capacity.--k4 �------ <br /> -1 :r - <br /> _ t t .� <br /> sposa• I N ld: Distance from nearest well_.._- ---'Distanee from foundation._____-IQ____.Distance to nearest lot line..:.___-.. <br /> Number of lines--------.. - ---------------------Length of eac lin -------------Width of trench...--,�_ 4----------...---•--- <br /> TyVT`of4iolter material. RC_C: x Depth of flter,aferiali.i/_ �-- Total length <br /> - __... - �SeeP g Pi •:,� Distanceto•nearestwl-- _ anon=1 : istance to"nearestg _line_"-Number of pits----- ----------- ---LLining material ��� m7� Depth---- ---------•---••-----.-.-.••••.-- <br /> eter <br /> Cesspool: Distance from nearest well----_------------Distance from foundation--------------------Lining material----------.-_______________.._..____ <br /> ❑ Size: Diameter------------------------------------ Depth-----------------€ I-------------------------------Liquid Capacity ------------------gals. <br /> Privy: Distance from nearest well---------------------------------------------;)Distance from nearest building-------------------.--_______ <br /> El Distance to nearest lot line------------------------------- ----- ) I <br /> - ---- •-------------_- ------------------------------•---•--------- -- •----------- <br /> Remodeling and/or repairing (describe):-------------------------- --------------------- ---------------------------------- <br /> Ix <br /> ' _________._._ __ <br /> I ••-•------ ---------------•----------•---••------ <br /> ;p <br /> ------=---- -----------••------------------------•--------------•--------------•---•----------------- <br /> ------•-------------------------•------- - i <br /> ----------------•-----I--------------------------- •- • --•------ -- ••---•- <br /> I hereby certify that;l'havfr,preparedjtkislapplicati6n and that the work will be done in accordance with Sen Joaquin County <br /> ordinances, State laws, �n *rules d,regulations of 'the San Joaquin Latal Health District.!LA A,1 ' 73 AQ f-ti?{.x 41• <br /> (Signed) (Owner and/or Contractor) <br /> -------- -- <br /> SY� -f-.-----=------------------------••---------------------------------------------------------`- ---(Title)--------•--•---------------------------..._..----------------- <br /> (Plot plan-'# showing size of lot, I�anon of system in relation to wells, buildi�i1 1. , etc., can be placed on reverse side). <br /> 4 FOR DEPARTMENT USE OILY <br /> APPLICATION ACCEPTED BYl ��_ d. } ------•--•-•--------.-_ DATE-------- <br /> REVIEREVIEWED <br /> WED BY_-. ------- -------•------------------------- ------------------ R----------------------- DATE---•------------- <br /> BUILDINGPERMIT ISSUED-----•,-------------------------------------------------------------------- -i-• _-------------- DATE---------------------------------------------- <br /> Alterations and/or recommend'ations:-------.----------- E..(---__-- <br /> -•-----------------••----------------------------• - 1-------------• ------ ----------- ----- •- •--•-i •--------- --- <br /> -••-------------------------------------------•-- --------- ----------------­---------- -- --------------------f..I <br /> ---------------- <br /> ------•--••---- <br /> - <br /> -----•--••-•-•-------••--- <br /> - ------- ------------- <br /> ---------------•----------------- <br /> --- <br /> FfNAL INSPECT-' -► .� e <br /> - _ <br /> - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED S•59 2M 5-62 ATLAS , <br />