Laserfiche WebLink
APPLICATION FOR SANITATION PERMIT = Permit No--d _____ <br /> (Complete in Duplicate) Date Issued/0_- <br /> 71-35 <br /> ssued/4_'71_35 y <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work heroin described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION-------kZ7.-E...... eetion--------•---------------- - <br /> Owner's Name Hen-- - - - - --------------------------- ------------; -------------------------- - -- --------------------------------- Phone--3-t%0273------------------ <br /> 4327 .E. Section <br /> Address------------ ------ = <br /> Contractor's Name---------- e18 - 3 <br /> --------------------------- ----------------------------------------- Phone----- -r3-;t-5�-- ------------- <br /> Installation will serve: Residence E3L Apartment House,'IE] Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> p_.II.P._+.-�.a�•.���If '.. � w�-w..w +„amu-r.. -.... <br /> Number of'living units-i------ Num1r ber of bedrooms _ 2'___ Number of baths -'7l__ Lot size __-_Q---x---],r5_Q-----------_-------________________ <br /> 1 4 <br /> Water Supply: Public system ❑ Community system ❑ Private LX Depth to Water Table ________ ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe El Hardpan ❑'*4� <br /> Previous Application Made: Yes ❑ No ® New Construction: Yes ❑ No ❑ i <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tan0oor cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well-----------------Distance from foundation .Materia <br /> __-_____ l <br /> ___________-____-__-_,__________________:____EXING No, of com artmenfs-------------------------Size------------=-----------_----•-Liquid depth.-------------------------Capacity----------------------- <br /> 1 <br /> --- ----------------- <br /> �Disposal FieldDistance from nearest we€i------------------Distance from foundation-------------r.._..Distance to nearest lot line----------------- <br /> EXIUING Number of lines------ <br /> ___#____________________________Length of each line-----------i c____-__'_____.Width of french----------------------------------- <br /> Type of filter matevial---------------------.----Depth of f€Iter material------4_:P.�'PJ--._-Total length------------------------------------------ <br /> Se­6page Pit: Distance to nearest <br />� wef__19_Q'777Di <br /> stanc6'f•om foundation-___ _____.Distance to nearest lot line_-_____5-......... <br /> Linwi�nmKaferial_pX_1C €-_-Size: Diameter______________________Depth___2� _ --- ___ <br /> _:__Number of p 1 <br /> Cespool: Distance fromtnearest <br /> Distance from foundation ---------------Lining materia-------------------------------------- <br /> • <br /> __Li uid Ca aci# <br /> ❑`�-= � - =Size:_Diameter------�-�x. � _----------Depth --: ----- - -- --•--------"- q Capacity <br /> 3 �_ -_ <br /> Privy: Distance from nearest eI __-------- -------------------------------------_ Distance from rie8 east E�uildin` <br /> ❑ Distance to{nearest lot'"line-----------------------` °--------------------------'----------------------------------------- ----------------- <br /> r <br /> Remodeling and/or repairing (describe)--------------Install_ln�---�1ew-_V�_ ' _ a�.---5 =A TL--- Q---f�X_ ---8. 31d---(_ —f_ .� <br /> maximum and hooking`up t©-__existing--lead'_cr _ __w_it __ald__l .nom-------------------------------------------- <br /> ---------------------------------------------------------------— r - <br /> -------------------------------------------------------------------------------------------- <br /> ---------------------------------------------------- -•-------•----V ---------------------------------------------------------------------------------------------------------------------------------------------------- <br /> I hereby certify that I have prepared this'epplieation and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of4he San Joaquin Local Health District. <br /> Dei t a R-------------------------------------------- <br /> (5igned)------------------ •------------------------------------•-------------------- - -----------(Owner and/or Contractor) <br /> Perr War ° <br /> By: yha11 ° (Title) Q�tltax`= ;r <br /> Y -------------- <br /> t (Plot t plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> - <br />' ' FOR DEPARTMENT USE ONLY <br /> I <br /> APPLICATION ACCO EPTED BY - DATE _--- ------------ <br /> REVIEWED BY ---------------------------------------- DATE C .. <br /> BUILDING PERMIT ISSUED ------------------------------- ------ DATE <br /> Alterations and/or recomnendations------------------------------------------- ----•---------------------- -------------------- ---------------------------- <br /> 4 I � � i <br /> = ---------------- ------------"--- --------- ' �` <br /> _________________-_____._____--_--- _______.__..______F__..___-________________ <br /> Of <br /> a 4 <br /> ----------- -----------------------------------------------I------------------------------------------ ---- ---------------------- ------------------------- - <br /> FINAL INSPECTION BY---------------------------------------------------- ------------ Date------------- - <br /> f <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130'South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> S <br /> s ES-9-2M 8-51 Revised W-2100 ' <br /> ys <br />