Laserfiche WebLink
LFOR OFFICE USE: /- G-� — h �-e' 6' , <br /> _--.._............."._......... ....... . APPLICATION FOk SANITATION PERMIT Permit No. _� .C?.._...... <br /> .................... ................. .... .. - (Complete in Duplicate( <br /> Date Issued 103. . <br /> r..---------...."._.._..._.____.__..._.... ".. This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This applicatiop is me e n mpli ith County Ordinance No. 549. <br /> fS � ............J� ' y <br /> JOB ADDR S DLO ATION ---- . .T.fala...�� T-�' -----------.V...t�h.10.1-31.4k.------W <br /> Owner's Name----------...) ....-L O Y.e-ds2 - ----......-- ....._..- - - . '---'-- --------- ---.... Phone............................--'-' <br /> rAddress...-------•-...5il............................. ......... - -- --- - -.... _..... _..........- <br /> Contractor's Name...-L�3.]X, .... ..--'......._- <br /> .3?r.0.................... Phone._................._-......... <br /> Installation will serve: Reside cf e Ef Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> W. jam <br /> Number of living units; .-/---- Number of bedrooms .3.. Number of baths .%... lot size ................�...•1T....�r....-...................... <br /> Water Supply: Public system ❑ Community system ❑ Private X Depth To Water Table j ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ® Clay ❑ Adobel Hardpan ❑ <br /> Previous Application Made•. (If yes,date--------------_....) No ju New Construction: Yes A No ❑ FHANA: Yes ❑ No <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: ! v <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well.!_^.......Distance from foundation....Ae.........Material----- luQ.P.. ............ <br /> jJ No. of compartments._.-_._a----------Size---J, --A.................Liquid depth......40----------------Capacity....S:Oo-....... <br /> Disposal Field: Distance from nearest well.--Z' ..Distance from�•foundatign.- ..Q........Distance to nearest lot line....... <br /> ,® Number of lines............... . z{: ------Length of eacfi I(ne_J6..f7,�......Width of trench....... <br /> �e.......--.. <br /> Type of filter material.--/- ..KnN.=..Depth of filter material....--ZZ........"Total length....... .J 1P.'--.---!--Z=--�- <br /> Seepage Pit: Distance to nearest well----/ -iPt.._.Distapcg fttQQm foy ndation--.--_:z®__Distance to nearest lot line---:3--.a. <br /> Number of pits....-._�--------Lining materi�l!.Ll:G4'-..Size: Diameter --Depth._.iZ.-��_'-------------- <br /> Cesspool: Distance from nearest well.._-------------Distapce front.foundation-------------------Lining material--------....-.................... <br /> .... <br /> _. ❑ Size: Diameter----------------.....................DeptA--...............-........................ ......Liquid Capacity---........-....--.......gals. <br /> Privy: Distance from nearest well-----------------------------------:-----.-----Distance from nearest building........................... <br /> 0 Distance to nearest lot line-------.........-....................................--................-............-'................................................... <br /> Remodelingand/or repairing (describe):...................................---------......................................................................................................... <br /> .......... -- .. <br /> L -----------------------------------------------------------------------...-----------------------------------------------------------------------------------------------------------------------------------------......... <br /> -------•------------------'-----------------------------.......-----.................................. ...........................................................................................---'-' ....... <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinancesC�S/taytJe lows, an rules dreg #ions of the San Joaquin ocal Health District. - <br /> lee (Signed)_--✓ !{hAJ ._ _ .. - -- -- . - - '`- ------ -------... �Q�frCyL< F/1 -- ......................(Owner end/or Contractor) <br /> By:---- ...- . ... .Title)------------------------------------------- --.............. <br /> (Plot plan, showing sae ?f--Io , ocati system i elation to wells, buildings, etc., can be placed on reverse side). <br /> t. <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-----'.7_-----. - ::"V----........_.._..----................. ....... DATE.. �L -- .:.. <br /> teteREVIEWED BY.---------'--- -----------_.........----------------------------- ............._................ DATE............-----------------------------------......... <br /> BUILDINGPERMIT ISSUED------- ...-- ------............... ..--------- .............tete. DATE--------... ----------------------------------- <br /> P��en -a.t..i,or.n.�s�:.-..0..".. .......,...�Alterations and/or re ..-..._--Z, tete"tete.._..-tete.�1LcY1-2�.tca' �'-'--`--- <br /> .......................... <br /> ............G.-. /yrter'L•„ <br /> i <br /> �-- g.-a�-c-et <br /> -----....... _. �• tete !r„-_.f.^:'--"--'-'--� ----tete.------- -----.'z�--�:-1....i�----......-------'-- .f-s. .--- ----'-----"-' ----tete <br /> _"-. <br /> -r.Z° -Qay T1-_s <br /> 1- �c <br /> tL2- - �[=���' — ------------------- tete.."tete <br /> FINALINSPECTION BY:---yr.`.--------A--------- _tete . ,..�......- `�-e�} . . .....-r�--�--..............__.._._.._.___.......----..-tete <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 Wut Oak Street 124 Sycamore Street 205 Wut 911%Street <br /> Stockton,California Lodi, California Manteca,California Tracy, California <br /> ES 9 REVISED 8.59 2M 5-62 ATLAS <br />