Laserfiche WebLink
.:Y FOR`OFFICE USE: <br /> -------------------=-------------------------------------- $. <br /> I __ ___---.__, ,__--__-_--________________ ___ APPLICATION FOR SANITATION PERMIT Permit No. _. ..'.J� <br /> (Complete in Duplicate) `y / <br /> T This Permit-Ex fres 1 Year From Date Issued ©ate Issued ._. ,1 <br /> r !!! <br /> Application is hereby made to the San ,laaquin Local Health Dis#riot for a permit to construct and install the work herein desc�rib�ed�t.{� <br /> This application is made in compliance with�County Ordinance No. 549. <br /> 10� ..,.. .._. <br /> --- <br /> /} x t. �� of----- EDA- <br /> JOB ADDRESS AND LOCATION..., ----- - .�'fl}N��Cf4 ----.�.b'--• --�.��1,�--------- --------- <br /> Owner's Name 1�._ -- _R _ d. .-j- _I-------------------------- ---------- ------ Phone------=-----------------I.......... <br /> Address----- T 1--------aax-----...�1.. Cf} :.-.. <br /> 4 <br /> Contractor's Name------ - .....E,....... <br /> CA 'C.-1--L ------------- 10,------- � . ------------------- Phone----...----------------- <br /> _ -- <br /> Installation will serve: Residence 0' Apartment Hoe ❑ `'Commercial, I]` rallerlCourt ❑ Motel ❑ Other ❑ <br /> ] size Number of living units: --1---- Number of�bedrooms _�-_-,Numbel,)fx a hs _Z.Lotsize .-Jq R-"6=�---------------------- <br /> ❑ C� p >G _ .. <br /> Water Supply: Public system ❑ C fy system_ Private De th to Watar Table -g- ft, i <br /> Character of soil to a depth of 3, eet: Sand [Y;✓Gravel ❑ Sandy Loam El Clay 0' in E] Clay [j Adobe E] Hardpan E] <br /> Previous Application Madd (If yes,date--------------- <br /> ate_............. No Er"-'New C struction: Yes to E] FHA/VA: Yes E] No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic_tank or cesspool permitted if public sewer is available within 200 feet.:) , =. <br />�—.��..�.r�rwaYs= �F' <br /> Septic Tank: Distance from nare 'Iw'ell ---- fQistance from foundation--------------- -__Material --------- ---------------- ---------- <br /> 0(0;r/AlC No. of compare'Ti ent%A--A-A iter,__ !Size--------------------------?I-----Liquid bepth-------------- ------Capacity----------------------- <br /> Disposal Field: Distance from nearest well.-.1-5-0.___11-ength <br /> Distance from four�'dation----.f� JY_---.Distance to nearest lot line_--43-•. <br /> I:�DD G . .�Numbel. of lines------- --I <br /> f `� /�� - --------- ------- --------length----------------- -___--_.--.. <br /> 'T <br /> Seepage Pit: Distance to nearest well--------------------jDistance from foundation---- --___.Distance to nearest lot line------..-------._ <br /> ❑ Number of pits-1__________________Lining material---------------.- Size: Diameter------------------.. .Depth------.--._---____----_____---- <br /> II. _. A0 <br /> Cesspool: Distance from nearest well--------------- Distance from foundation---.I. ...t.--.Lining material------------- ------------------------ <br /> -Si <br /> e: Diameter--- ----------- <br /> ❑ _ Depth -- _----Liquid Capacity----------¢=---------------gals. <br /> Distance from <br /> st <br /> Priv�y�t Distance oto nearest lot line..l .---F -------_--------..._---_-_:...Distance IIr� Barest building ---------- --------------------- <br /> --------------------- <br /> Remodeling and/or repairing (describe): -___.-_ --------------------- ---- <br /> -------------------------------------=--------------------- •----•-------- -- ------------------ ---- -------------------------------------------- ------------------- -- <br /> ------------- <br /> - ------- ------`-------------------------- <br /> i s I� I i <br /> - - --------------------------------- <br /> I hereby certify that I have prepared this application and that the work will 6e done!n accordance with San Joaquin County <br /> ordinances, State laws, and rule and regulations of theStan Joaquin Local Health�District <br /> F _ Owner and/or Contractor <br /> (Signed)----- ,` ------------ ------------------ { / ) <br /> I e <br /> BY: ----------=--------`-`-------------------"-----------_------------------------------------------------------------(Title}-------------------- <br /> V T M.. <br /> i(Plot-' Ian;showing size''of-lot;location=of�system:in=vele io to-wells: buildings,-etc., .can-be_placed_on-.reverse,side).- <br /> FOR-DEPARTMENT USE ONLY <br /> it <br /> APPLICATION ACCEPTED BY 1 ------------ ---------------------------------------- DATE------- � � <br /> REVIEWED BY------------------------------------ „ ? --------------- DATE---- - 1 <br /> BUILDING PERMIT ISSUED------------- }-------=---------------------------- --------------------------- ------------ DATE.---------------------------------- <br /> Alterations and/or recommendations -------------------------------=-------------- -------------------------------------------------------------------------------------------------------------- <br /> ---------- <br /> ----------------- :--- <br /> -."--- ----- ----- ------------- ---------------------------------------------------------------- <br /> ------------------------------------------------- <br /> ----•- ----- . ----------- ------- - --- --- -- -Y ----------------------------------------------------------------------------....------.-------" <br /> ------ ---- -•- -----------------------•----------------------------------- <br /> FINAL INSPECT] :..-. - <br /> r- - ----- Date �­-.;2� .—I!V-- / <br /> - ----- - ------------- <br /> i SAN JOAQUIN LOCAL HEALTH DISTRICT 1 <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 8-59 3M 3-'63 F.P.CO. ' <br /> a rs z� i <br />