Laserfiche WebLink
�. Permit No. .4-fl-•--1-•--- <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete in Duplicate) Date Issued .�--b i-f—S <br /> AI'cation is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> pp <br /> This application is made in compliance with County Ordinance No. 544. <br /> t ► Cal i f ------------- ------------------------------ <br /> JOB <br /> ADDRESS A D LO ATION_.. Rt- ¢ '9 ' <br /> Owner's Name----- --U-=Icn---------------Zj_�-_gleT' �L-�&V <br /> Address Cama '" -talk.. h � .._C 11 erg__ on_.E_, of--- ---------------------------------- <br /> ------------ 5 <br /> Phone-------- -- - ------ <br /> Contractor's Name---------- ---P-1 -1---1-ae------------------------------------------------- <br /> Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [I Other ❑ <br /> Installation will serve: Residence ® p <br /> Number of living units: 1----- Number of bedrooms ---2-- Number of baths . z:_ Lot size __-13.4X145xl2,7Y,241X--30..-_ f <br /> Communit system ❑ Private © Depth to Water Table 40__ ft. i <br /> Water Supply: Public system Ely y Clay LClay Adobe E] Hardpan <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel F1 Sandy Loam 17­1Yoam ❑ y ❑ , <br /> ED <br /> Previous Application Made: Yes ❑ No a New Construction: Yes ® No ❑ <br /> k TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.t <br /> Distance from foundation-_."__S__....__...Material----Cement-br-�.G%---- <br /> Septic Tank: Distance from nearesT wel4_."__7�"----- r <br /> ------Size _•._:,4__X4---- -----Liquid depth---5---0 --------- Capacity, a:�Q- -------- <br /> from <br /> ------- <br /> No. of compartments..._.__.._....-- r <br /> Disposal Field: Distance from nearest well----------- _Distan of reach line foundation -__- .----Distance thofttrenches# loft line----------------- <br /> Disposal <br /> -------------- <br /> ❑ Number of lines--------- -Total length--------------------------------•--------- <br /> Type of filter material____""___________________Depth of filter material___._.__.____..___.-. <br /> _ Distance from foundation.--�.��--------Distance to nearest lot line__"_.3.�.----- <br /> Seepage Pit: Distance to nearest well____1_00"-------- Size: Diameter_-__-- Dept h------3C! <br /> 4 1 i Linin material____"-br-i,Gk- <br /> f�,umber of pits.__-"__�------------- g <br /> ing <br /> Cesspool: Distance from nearest well_---__-____-----Distance from foundation------------- Liinuid Ca material-------------------------------------- <br /> Cesspool-. gals. . <br /> ---De th----------------------------- -------------------- G — . P Y ----_--- . <br /> ❑���,...�.- Size: Diameter _ -p �� re _ <br /> ............................ --------------------Distance from nearest building------------------------------------- - <br /> Privy: Distance Brom nearest well <br /> -------------------------------- <br /> --- <br /> ❑ Distance to nearest lot line--------_-------------------------------------- <br /> -------------------- <br /> l ------------•-------------------------------------- ----------------- --• ` <br /> Remodeling and/or repairing (describe}: : <br /> ------�e-W- -------------------------- -- ------------------------------------•------------------- <br /> ------- <br /> I hereby certify the+ I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> --------•-- <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> Delta, ZZC: --------------------------- (Owner and/or Contractor <br /> By=-------••---P�r_r hr rtn :ds <br /> ---------------------------------------------------------(Title)-----�xe.Cl.---S�:,�x��------------- -- -------- - - <br /> (plot plan, showing size of lot, location of s+em in relation to wells, <br /> buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> ------------------------------------------------------------------- <br /> DATE- ------------------------------------------ ---------- <br /> APPLICATION ACCEPTED BY-------- -------------- ---- D -_ -----------__-_-_---._-.- <br /> REVIEWED BY-------------------------------- ------------------ -------------------- <br /> ------------------------------------------------ <br /> -------------------- <br /> ------ ------------------------•----------------- <br /> DATE----------------------:-----------------------:-------------- <br /> BUILDING PERMIT ISSl3ED------•-------------------- - i=------ •------•---------------•--------- <br /> ----------------------- ------------------------ - <br /> ---- <br /> Alterations and/or recommendations:_-._--_--"--------- <br /> ....................per ray----------------- <br /> i_____ ___________________e�� <br /> _____________FINAL INSPECTION - <br /> SAN JOAQUIN LOCAL HEALTH <br /> 300 West Oak Street 132 Sycamore Stree+ 814 North "C" Street <br /> E30 South American Street Manteca, California Tracy, California <br /> ► Stockton, California Lodi, California <br /> rr n Ou in 11 W-2IO0 <br />