13407 - Laserfiche WebLink

Home Browse Search

.AK!wFQROFFICE USE..,o- --------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. i��......... ---------------------------- - --------------------- - ------- ---------------------- ------------ -- - ---------------- (Complete in Duplicate) - -—- ----------------------------------------------- ---- 'This Permit Expires I Year From-Date Issued Date,Issued Application is hereby made to the San Joaquin Local Health District for a permit t o cons t r u c t and i n sta-i_It�-r �f-7-in-Je-s—cr Ce-J' yi This apiDlicaflon is made in compliance with County Ordinance No. 549. ON WOLPF- Rt> . WEG7r SiDEz IrK 4d_�6 F-Colvi> I-f6Q5E_ FAOM Ho J5R_ _ - I , it An NO 0 "ikDDRESS'ANC - ------- 0) 6 :5 -9 4�1? 5P ----------_....... -------------_------------- Owner's Name-=-- Za -- _-- 5., Phone ----i_4? -- ----------------- --------------------------------------------- -- -------- ................2- Address------_--------4BPV.M-------------------- Contractor's Name----- 0_W_AJ_a)z;.-------------- --•----- ------------------------- ----------------------------------------------------- Phone-.............__--------------- Installation will serve: ResidenceA13—Kpartmerif House E] Commercial E] Trailer Court E] Motel ❑ Other C] Number of living.units: )---- Number of bedrooms -!7—. Number of baths --/--- Lot size ------------------------ Wafer' Supply: 'Public system [] Community system E] Private e Depth to Water Table�Pft. Character of soil to a depth of 3 feet: Sand ET/Gravel E] Sandy Loam8rClay Loam 0 Clay F1 Adobe E] Hardpan ❑ Prevf&6`s',Application Made: (If yes,date....................1 Noxa-.1"New Construction:' Yes �/No [I PHA/VA: Yes E] Nog®' --� TY-PE40F. INSTALL-ATION+ANDSPECIFICATIONS: (No septic tank.or cosspool,permiffed-ifFpu6lic,sewer-4s-available-wifhin 200jee_+_.), Septic T k: Distance from nearest well--- _.NDistance%from foundation----/0-- ----Mafer;aI__ReF_1>VU_0jQt__> No. of compartmen Lipuid-clep h fsZ�2�tt-sf`z,_3iV%_k1 - ------------------Capacity........g ------ Disposal Fi-6ld-- Distance from nearest well..5 Distance from foundat' ..._..W-_ ----Distance to nearest lot line----- Number of lines------��_ ---Length of each line-A40 ----Width of trench______ ---Total length------------------------------- Type of filter material__B ---Depth of filter mat rial-_ - 4 �%a 4,1 1�-45 1 Seepage Pit: Distance to nearest well----------------------Distance frokOoJndaitlon---------------I.-_Distance to nearest lot line____-____-_--.__. ❑ Number ine------------- Number of pits----------------------Lining material----------------.------Size:Size: DiameteA----------------------Depth----------_-------------------- Cesspool: -Distance fro' nearest well------------- -------------t1ining material--------------•----------------------- 11 Size: DiamePer---------------------------------------Depth--)--------------------------t-------------I.-Liquid Capacity-----------------------------gals. Privy: Distance'frA nearest well----------------------------- -----------------Disfanctfrom nelarest building------------------------------ ---------- ❑ Distance to -gej." lot'line.-I A I N Remodeling and/or repair;`n`�.Jscribe):--------------------------------------- ....... ----- -------------- ------ . ........ -----------------------------------*------------- ------------------ --------------------- -------------- ---------------------------------------------------------------------------------------------------------------- --------------------------------------------------------I----------- -----------•----------------------- ----------------- # -------------i----- - " ---------------------------------I--------------------------------------------------------------------------------- ------------------ I hereby rfi y that I have' reIpared +his application and that the work will 60e done 4h accordance with San Joaquin County ordinances, S aws and and reg a of the San Joa"quin Local Health�Disfticf! -----------PT ------------- - -----W�5E------------- (Signe ----------------------------------- --------------------(Owner and/or Contractor) t- fBy:------------- ---------- - (T+Ie) - ------- ------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can 660 placed on reverse side). II FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-L T.-R-Z------------------------------------------------•---------------------- { ATE----- 9 71-_�/, -------------------------- REVIEWED BY----- ----------------------I 'ATE---------------- - - ---------------------------------- BUILDING PERMIT ISSUED--------1-------------------------------------------------------------------------------------------- ATE----------------------------------------------------- - Alfer;fi-ors,and/or, ..... .. - --------------------------_� ------------------rst.. ------------------------------------- - ------------------- ---------------------------------------------------- ----------------------- ------ - ------- ---------------------------------------------------------- ------------------------------------ --------- ------F---------- -----------------------.-_.•-----------------•-•___•------ t—j"17-�_j--- ----------------------------------------- --- -- - ---------:------- -------- - -- -- --- -------------------------------------------------..-.._.-----------------•-••-------------------------- - IT--------- ---------------- ------------ ---------- - ------- ------------- ------- ----- ----(L----------------------- -------- ------------------------------------------------------------------- -------------- FINAL 'INSP - -------- Date--------- '_ 41------ SAN JOAQUINLOCAL HEALTH DISTRICT 1130 South American Street 300 West Oak Street 124 Sycamore Street 205 WiAt9th.Sireet Stockton,California Lodi,Callf4ornia Manteca,California Tracy,California ItM-9 REWDED 0-59 F.P.C .2M 6-60