Laserfiche WebLink
Metadata
Document management portal powered by Laserfiche WebLink 9 © 1998-2015 Laserfiche. All rights reserved.
rUKUN-R-t: USE:_ <br /> I :=- <br /> -------------------------------------------------- ------ - 79 <br /> ---- ------------------------------ ------- -- j <br /> APPLICATION FORSANITATION PERMIT Permit <br /> ------------------- ------------- -------­ I - (Complete in Duplicate) Date Issued <br /> ---------------------------- ----- ------------------ - This Permit Ex fres I Year From Date Issued <br /> A .- I 1 2S-7 -Z-7This <br /> is hereby made to the San Joaquin Local Health District for a permit to-construct and install the work-her'6in described. <br /> 's applicafion is made in compliantwith County Ordinance No. 549. <br /> L( <br /> hwol <br /> RIP01\j <br /> JOB ADDRESS AND OCXTION-t L <br /> ...... Pell <br /> Owner's Name--------WAZ­11 ...........--------------•--•------...... <br /> -- -- --------------------------------------------------------------------- <br /> Address.............. T ------------- Phone_--------A d-::--------- <br /> ---------------------------------------------------------------------------- <br /> Contractor's Name- <br /> ------- i'i' .7" a ----------- ---------�OA*Ife_----- - ------------- .............. ----------------- Phone-- .. � <br /> Installation will serve: Residence ;N. Apartment House [] Commercial-0 Trailer Court 0 Motel [3 Other C] <br /> Number of living units: -------- Number of bedrooms­�-- Number of baths ---ALot size --- <br /> It ­"!�/?w-g��h......----------------------- <br /> -Wafer Supply: Public system Ej Community system El Private PW Depth to Wafer Table IZ—. ft. <br /> 3 <br /> Character of soil to a depth ofJ I <br /> feat: SandE] Gravel [D Sand Loam ClayLoamo Clay [] AdobeC] Hardpan (:] <br /> Previous Application Made: ilf yes,date--------------------} NojX Now ConsfructioK:` Yes-0 - 1\16JK- FH-N/VA-.- Yes 0 No [:1 <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <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---------- ---------Material 4 <br /> 0 No. of comparf4ents-,--------- ------------._Size------------------------­-----Liquid depth.-------------------------Capacity--------- <br /> I - J. -------------- <br /> Disposal Field: Distance from nearest well­,� <br /> ---Distance from foundafion--4Z0.........Distance to nearest lot line 00 <br /> Number of lines---I------------X---------------Length of each line-,-,.-/ ----- ---47-- <br /> :;? -------Width of french.- <br /> riaI­-/2r-A:!�CeA--Depfh of filter material--_!e-------.-Total length--------/gv--,t4__"_..----=•-----•-"_l <br /> --- ------ ---- <br /> Type of filter mate <br /> .............. <br /> Seepage Pit: Distance to nearest well------ ---------------Distance from foundation-------­----------LDistance to nearest lot line...___.._._. <br /> 0 Number of pits---t-----------------Lining material----"----------- ----- Size: Diameter-------_--- <br /> ----------Dept h--------------------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_.__...__...._____..__....___. <br /> El Size: Diameter----'I--------------------------------Depth----------------- ----------------------------------Liquid Capacity. .... <br /> I ------------------------­gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distancefrom nearest building_______-_:_________._____-___ I'S, <br /> Cl Distance to nearest lot line________________.___- <br /> Remodeling <br /> ine--------- <br /> Remodeling and/or repairing (describe):----_---I <br /> -----------------------------------------•----- <br /> -•-•---•-+- 1WO,-A ---------0,o---------- <br /> --------------I------------I----------- --------I-----------­-- --------•---•--••-----•-----------------•------------------------------- ----------------------------------------------------------------- <br /> -------- -------------------- -i��--- ------5;k-s ---C.-7-------------- <br /> ------------ -----------------_•_---------•---•------------------(----------------------------------------------------!*------------------------------------------------------------------------------------------------------- <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 /> laws,ordinances, Statand rules and 'regulations of the San Joaquin Local Health District. <br /> {Signed)--------•-•-L I 0�I�- '--WPV K­a� <br /> ------ --------------------------------------------------- (Owner and/or Contractor) <br /> By:--------....I i "- -- ----- ---- <br /> ­ ----------------------------(rifle)------ <br /> in j, <br /> (Plot plan, showing size of lot, location on to wells, buildings, etc., can be placed on reverse side]. <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY-- lip <br /> ----------7--)A,0------------------------- DATE------ 1/_`_.6 --�� <br /> REVIEWED BY--------------------------------------------- ------------------------------------------------------------------------------- DATE--------•----------- ---------------------- <br /> BUILDING PERMIT ISSUED <br /> Alterations and/or recommendaf ions;._ <br /> -----------------------------,--------------------------I---------I. ---------- - ------------------------------------------ ------------------------------------------------------------------- <br /> ----------- -------------- --------------------------------------- -------------------------------------------------------*---------------------*----------- <br /> -------------------------------------------------------------------- <br /> ----------------------- -- ............ --- --------------------------------­------------------------------------------------------------------------------I----------I------------------ <br /> -1-------------- -1------------I--------- <br /> ------------------------------------ ---------- ---- - .­- ............... . --------- ------------*--------------------------*----------------------*------------- <br /> � - ----------------------*--------------*----------------------------------- <br /> LL . , - ---------*- - <br /> FINAL INS is <br /> -- - - - -L a " V Dfe­-------- -------------------- <br /> I SAN JOA QUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Servet 124 Sycamore Street <br /> Stockton,California 205 West 9th Street <br /> L ad[,California Manteca,California Tracy,California 9 REVISED 8-59 2M 5-62 ATLAS . <br />