16574 - Laserfiche WebLink

Home Browse Search

FOR.OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. t (Complete in Duplicate) Date Issued _:__ T- � ---------------- ----- - ---- -- -------- This Permit Expires 1 Year From Date Issued - -- -- Application is hereby made to the San Joaquin Local Health District for 6`permit to construct and install the work here i described. G p This application is made in compliance with County Ordinance No. 549. .E 4 ww }4 O _ _ ;V------------- :______._... ------- JOB ADDRESS AND LOCATION----Z--__-�- -------M-YkN------- ---------------- Owner's Name---------------V-_I-Pd7t_1 ------------------�-I_Q�_1- _ _CJ`�y. Phone. ----- ------ --- ,[ -�N.� -•------------------- -1' -_------------------ --------------------------------------------------------�1---- -------- Address--------------_-- --------------------------------------------- _ . f Contractors Name-----` �L911-1� ---------------- is Installation will serve: Residence DR"'Apartment Hous--El Commercial E] Trailer'Court ❑ Motel [:] Other ❑: ' 41 � L.Number of baths 1.--- Lot size[-'I��-- --G�•�-•---------I-t-----`------- Number,of livingtunits:;_4__ Number of bedrooms __ Water Supply: Public.syste ❑ ommuyy kn ❑ Private W Depth to Water Table ------- ft. I Character of soil to a depth of 3 feet: Sande Gravel ❑ Sandy Loam'.' Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Preyious Application Made.-(If yes!date ---------) No New Construction: Yes No ❑ FHA/VA: Yes Q No " { t y' k, = �- TYPE OF INSTALLATION AND;SPECIFK ATIONS:-r �4-'�-— '"''" """ - '" "� `� " • � (No septic tank or cesspool,p rmitted-if'public sewer is available within 200 feet.) `=7.7 i Septic Tank: Distance�fr m nearest well--- __---Distance from foundation___�4P#�--.Material________----------------______------------------- N61 -___- _-_._____-. �N61 No. of compartments------- Size___.. ' Liquid depth___—r --------Capacity — r p r•om-nearest well --°�.'.-Distance from foundation-----/40 _.Distance to nearest lot line___S______. .,.y+�a.,,.:t,. .- tiL+,77--------------- -e,-- ,.+e-- -^,-.F Q '---------- r �( (-A 6r- Number of dines __.__-. - OGf,;S---- De th off'eac}i line___'_._ ___ ___�� -"Width of4 rench.___R/�� .:__ V Dis osal Field: ' Distance 9 -�1- HDj7.� Type of.filter matenal_- ..._------- p filter material----- ---------.Total length--- - ---------------- Seepage Pit:Y- Distance to nearest well-----------------------Distance from foundation____________________Distance.to nearest lot line:___ ❑ Number of its----------------------- 9 # ------------------- Size: Diameter Depth s ool: Distance from nearest well____ _________D stent # Linin material___ e from foundation___._______ ______Lining material____.._______-_____._____.______-.- Ces p #p - f '� ``� }} 0 Size: Diameter----- ------ -----------------------D�--th----------------- ---Distance �rom newestJbe�Capacity.---•--------- =-�---------gals. __ �p Priv Distance,from nearest well---------------- ilding-I----:---------------_;------------------ l Y' _ _' -------------- ❑ Dista rice to nearest lot line_ ` ----=--- --------------------------------------• ------ --: -. ` M+4 -- �-----I------------------- ' S� 4'G y Remodeling and/or ,repa�r.ing (descnbe)�----- ��-- --�-r�•J"E-a<-rim------ ---��----�--------f�.��_ -_- ----------- ----- -"--- --�0%V I+C ""'�-j` G * - --- --- -------------- -- - ---------- ee i t'�--"`"-"'"---- - -- - - ---- ---------------------------------------------------------------I- ----- -- 1 hereby certify tha,fd have prepared this app,�licaflort,and that the work will be done in accordance with San Joaquin County ' ordinances. State law and rules and regulations of the'San Joaquin Local Health District. # :. (Signed _ �� - _-- ._(Owner and/or Contractor) - -------------------------------------- By: _ _________ - �'-- _L. .� r By:.------...-------------- -------------- ------------------------------------------- 4f . - . (Plot plan, showing'size of.lot, location of system.in relation to wells, buildingetc., can b placedan-reverse side). kA FOR DEPARTMENT USE ONLY 1 ------------------ DATE___ D-- � r �`-�#I---------------- APPLICATION ACCEPTED BYE- -______ _ _ .� REVIEWED BY---------------------------------------- --- 1- .-- `' DATE` - BUILDI:NG,„PERMIT_.,]SSU.ED - - ----•- DATE -- --- .46 .-........w : s , .,rti.......r�w..• ,w..w...w•w�.,--.a ---•-------------------- -- Alterations and f or recommendations---- ------ -- - ---- . ---------------------------------------------------------- V ---- •-- -•------- ------ ---- F r •--------- ------ - --- --- --------------- -------- i-.. - ---------- --------•------------------ - t -------------- t -------------------------- ---------------------------------- - -------- t -- --------- - , -- - ---------------------------- fl PI NAL [NSP ------ -i------------ Date------/----� SAN JOAQUIN LOCAL HEALTH DISTRICT 1 1601 E.Haselton Ave. 390 West Oak Street 124 Sycamore Street 205 West 9th Street ilotkton,CaffFvrnla Lodi,California Manteca,California Tracy,California I � ES 9 REVISES 8-59 3M 3-'63 F.P.O o.