Laserfiche WebLink
Metadata
Document management portal powered by Laserfiche WebLink 9 © 1998-2015 Laserfiche. All rights reserved.
-vm %-/I Vik-C u0t: <br /> ------------------------ <br /> ;I- <br /> ---------------- <br /> -------------L-------------- <br /> ----------------------------- <br /> -------------f-------------- ----------- --------------- APPLICATION FOR SANITATION PERMIT Permit No, <br /> --------------- -- ------------ --------- <br /> 2 <br /> -------- (Complete in Duplicate) <br /> ------------------------ ------------------ ------ --- I <br /> This Permit Ex fres I Year From pate Issued Date Issued <br /> -(X7 0- <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein6?_� <br /> described. <br /> This application is made in compliane with County Ordinance No. 549. <br /> J0_13 ADDRESS AND LOCATJON <br /> ------ ----A-u.---------W <br /> Owner''s Name------ -&R D ........ E i V Tn ------- ------ Pho............................. <br /> Add -- -----Ut4l-Ok------Rk­------ <br /> Contractor's NameA1')N_TF5;A------fSEPT.lc I <br /> - ----- ---------------............................. ---- Phone <br /> Installation will serve: Residence [I Apartment House F] Commercial E] ailer Court [] Motel ........ <br /> Number of living units: ------- 45 0 Other <br /> UAiM/eviro ulvi <br /> oms - -- ('_ <br /> Wafer Supply: Public system E] Num6er o baithol-7 tit tsie��RX— <br /> TT -4 <br /> 0 <br /> Gravel ❑ Sandy 'Loam [3 Clay Loam E] Clay ED Adobe[I Hardpan 0 <br /> Character of soil to a depth of 3 feet: Sand <br /> Community system E3 Private Depth To Water Table <br /> Previous Application Made: ;If yes,clate--- ----- - ------.) No EK'New Construction: Yes El'No El 'FHA/VA: Yes 0 No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.} <br /> Septic T k: Distance from nearest well__/00_.Distance from foundation 10 M <br /> capacify._9 :q.. <br /> Field: 7 <br /> No, of compartments------1_51--- ------------- --------------Liquid depth '... .....6 <br /> Disposal Distance from nearest well.../0(2-- stance from foundation-___-- -----Dis-fa-ric-e--to'nearest lot line.___S_ <br /> Number of lines..___._-- le ------------- <br /> -IS ---Length of each line_5�--- of french---- <br /> Type of filter Depth of filter material-----16..........Total length-------.��a-C? <br /> Seepage Pit: Distance to nearest well_._,/0_0--------Distance from foundation <br /> Number of pits.._:.-_ foundation____, -------Distanco�fo nearest lot line_._ .___..__- <br /> - ----- -------Lining rri­a­terfa.l_,__FQ�;K__-Size:-Diameter_____________ ......t5b <br /> 7,, <br /> Cesspool: -Distance from nearest well <br /> Distance from foundation__.._________.-_-.Lining Lining <br /> ❑ ?_,Size: Diameter--------- ----------------I------------ <br /> -------Depth-----------------------------------------------------L;quid Capaci�y...`4- Is. I <br /> Privy: Distance from nearest well-..-..-. I - .-----..gals. 7 <br /> --------------- ------------------- - ------Distance-from nearest building............. <br /> ❑ D%tance to nearest lot line__'_� I --, - ------------------- <br /> ----------I-_---------------•-----------------------------•------------------•----------- --------------------------- <br /> Remodeling and/or repairing <br /> -------------------------------------------------------(d---e--s-c--r-i-b--e):---------- ------------- <br /> --------------------------- -----v----------o---- <br /> ---------- <br /> - <br /> ------------ <br /> - 'p ------------------------­----------------------------------------------------------------------------------------------------------------------------------------------------------------- -QA[_-. <br /> ------------------------------------------6-------1.45.1�a-----------------------------O-------F <br /> •--------------------------------------- <br /> I Hereby <br /> ---------------------------------------ihere6y ----------------------- <br /> -------------- <br /> cert' that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> rdinances.;Sfeaw and rules a eg I * <br /> ordinances, <br /> �a4tons of the San Joaquin Local Health District. <br /> (Signed)------ .. ...... <br /> ------------------- ------- <br /> -----------------------------------------------------------I----------(Owner-and/or Contractor)- <br /> By:-----------__.........---------------------------------------------------------------------------------------------------I---(Title)---------1--------- <br /> (Plot plan, showing size of lot, location of system in relafion to wells, buildings, etc., can be placed on reyer_se-- --------- ----- - ---- -------- <br /> side). <br /> FOR DEPARTMENT ONLY <br /> APPLtC,ATION ACCEPTED BY_REA6WE"D BY --- ------------------------- DATE-------- <br /> _Z�-----------T <br /> BUILDING PERMIT ISSUED-----------------------------•------- -------------------------- ---------------------------------------------------� DATE----------------------------------------- ------------------ <br /> • <br /> A?terafions and/pr recommen4fions: ------------------------------------------ --------------------------- DATE------------------------------------------------------------- <br /> ------------ ---------- <br /> ----------------------------------- c <br /> .- ,5 - ---------------------------- ----------- ------- --------------- -----_--------T__R ------------- <br /> ----------------------A <br /> ------------------------------- ------_--------------------- ----------------------------------------------------------------------------------------------------------------------- <br /> ------------­----------­-------------­­----------------- - - __-_ - ----- --- -- -1---------------------------------------------------------------------------------------------- <br /> ----- ---------- ................... ...... .. .... ---- ---- .......­ . ----------------- <br /> --- -- -- ----r-- - ------------------------------------------------------ ------------------------------------------- ........ <br /> FINAL INSP <br /> Date.-- _.: 1 __.`6 = <br /> SAN <br /> ate---SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street <br /> — 124 Sycamore Streit 20S West 91h Street <br /> Stockton,cafffornla Lodi,California Manteca,California Tracy,C6flfarnio <br /> ES 9 REVISED 8-59 2M 0-62 ATLAS <br />