Laserfiche WebLink
I-UKVNIU USE; '-�- t 1% <br /> ----------------------------------------------------- <br /> -------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. <br /> -------------j ------------------------ -------------- (Complete in Duplicate) <br /> Date Issued <br /> ............. --------------------------- -------------- This Permit Expires I Year From Date Issued <br /> made to the San Joaquin Local Health District for a permit fo,construc <br /> Application is hereby i <br /> I t and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> 11 Wf <br /> JOB ADDRESS AND LOCATION-- -----"----I-------!lRv ---...Lp <br /> -------------4----A--- 1 <br /> ---- <br /> ----- . <br /> Owner's Name.._JONAI........ ZIK .- <br /> Phone.j�--------- ...................• <br /> Address.......... ............ <br /> ... ................................................... ----------------­.............................................. <br /> Contractor's Name ll -------0..VbM� ---------------------------------------------------------------------------------I Phone-----I.......................... <br /> Installation wilfserveResidence E] Apartment-,lpuse ❑ Commercial E] Trailer 0 Motel [:I Other ❑ <br /> Number of living units: .___ Number of . ', <br /> -lumber of baths._ ______ Lot size ------- ......... -----.. ....... <br /> ------ <br /> ZM <br /> -6e'pth t Water Table/D <br /> Water Supply: Pubic system El Community system [I Private 1�v __­.. <br /> Character of soil to It ft. <br /> a depth of 3 feet: Sand [I Gravel E] Sandy Loom ff Clay'Loam [j Clay [3 Adobe E] Hardpan 0 <br /> Previous Application-Made: (If yes,date......... .......... Nok New Construction: Yes No ❑ FHA/,7V1, - Yes E] No Er" <br /> TYPE OF INSTALLATION AND SPECIFICATIONS; <br /> k*k or cesspool permitted if public sewer is available within-200-feet.) <br /> Se k: Distance from nearest well-50----Distance from foundation-_____O------ <br /> ,(No septic-fan <br /> 1__.Ma e R D WOW> <br /> f ial---41-. --------------- .. . ....... <br /> �'�o. of compartments___.__.....:2------------Size_3.Xe7_X_577__Liquid depA.......J'/T .............capacity......I...CJ <br /> .....4P 4__ <br /> Disposal Field: :Distance from nearest 1eII___,_1!F0____.Disfance from founclatiol.-JO....LD-istance to nearest lot line_-- ..-.. <br /> �� <br /> Number <br /> ine--- <br /> Number of lines_...----- ...... ------------Length of each line-•----56�' 1-Width of trench--- <br /> Type of filter g7 <br /> --------------------- <br /> Type of filter material---/ ..............Total length______---- ..... --------------- <br /> Distance to neare ;n—ce fr-o7n foundation-------_-----------Distance to nearest lot line--------------- <br /> Seepage Pit: --------------Dist <br /> Cl Number of pits------.._*02ri-Lining material-----A.I-----------Size: Diameter!------------ --------Depth-------......____..---...--___-..Cesspook Distance=fromnearr'• <br /> Nstj .................Distance fro Im. foundation - -- -----------__.Lining material-. <br /> ------------ <br /> ❑ <br /> Size: Diameter----------------I--------------------Depf'h--=....4-1--------- -----------I'.Liquid Capacity-----------------------_---gals. <br /> Privy: <br /> Distance from nearest 411----- ------------- - ---------Distanc*e lr-567�i nearest building------------------------------------------ <br /> --------------------------------------------- <br /> ID Distance to nearest lot line <br /> Remodeling and/or repairing (describe):------- <br /> fi <br /> -!Am------------------------**-----------------------*----------------------- <br /> -is ­ ---------------------------------- <br /> ..............--••-.............------------------------------ --------------------------------------I --- -----------11-1-----------------­------ <br /> --- <br /> ---------------------- ----------------------------------.................!-------------- .......17--............I.............. - <br /> ----- <br /> ----------------1-------------- -------------------------------------------------------------I----—-------------_--------------------4,A-, ------------------*------------------------*--------------- <br /> I hereby certify _------------------------------------------------------------------w--------- - <br /> that I hay red application and that the work will �e Aine in accordance with San Joaquin County <br /> e <br /> ordinances, S e I!' d r es and regale ons of the San Joaquin Local Health' District. <br /> #;�p n <br /> (Signe -------- i----------- <br /> A� ....... --- --- ------------- ------- ----------------------------------- --------------- -----••-----------{Owner and/or Contractor) <br /> IL <br /> ------------ ---------7------- ........--------- <br /> ------------------------------------------------------------- {Title}--------..-..------------------------------------------7------- <br /> size of-lot,Iociation of sysfem�in relation to wells,'6uildin-�_ifc..7 can be 101,ii- 'on-on Ye4eR—se 6d 41"- <br /> gs. a <br /> (Plot I showing <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACfC' EPTED BY-------7_7­L_,;�_,-_0__I------------------------- -------------_-----------_-i--------- DATE-----/— 7 e7 <br /> I , � I � --—_----------- <br /> REVIEWED BY-------0---------------------------- i <br /> .......... DATE............. <br /> BUILDING-4&Ifjj�_S'_U IELJ------------- ----------------------------------------- --------------- <br /> Alterations and/or recommendations:; ------------------------ %go" Viwwiii---------------- DA E------------------------------------------------------------- <br /> -------------I ­­------------------------------------------------------------------I------------------------------------------------- <br /> ------------------------------- -- <br /> -------•---------------------- <br /> -------------I—------------- ...................... ---------------------------------- - ------ - - ------------------------------------------------------------------------------------ ------------------------ <br /> ------------------­- ----------- <br /> . <br /> .......... ............ <br /> - ------- -------- ---- --- ------- ----------- <br /> - ---- --- ----- ------ ------- --------------------------------------------------- -------------------- ---------•-------••-------••----- <br /> •--------------------------j( <br /> -------------------------------- <br /> ---------------------------ji I - <br /> .................... ........ - ------- ------------ -- -------- ------ - --------­------------- <br /> ------------------------------------ <br /> -------------- ----------------- ............. <br /> mLJ <br /> FINAL <br /> INSP -- ---- Date---------415�1 <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycomoro Street 205 West 91h Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> 4 REVISED 8.39 ZM 5-951 ATLAS <br />