20697 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE; :_f-414K__ ------------- 52 APPLICATION FOR, SANITATION PERMIT Permit No. 2..!��f -------- - - ---- ---- ------- (ComplefS in Duplicate) Date-issued _ ------------------- -- -------- This Permit Expires I Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein cltsc'ribed. This application is made in compliance with County Ordinance No. 549. ----------------------- JOB ADDRESS AND LOCATION---- ...... 7- ------------m - - ----------- Phone---..---------- ------ -------------------- Owner's Name-------2_7/zz -------- -------------------------- -------•------------ -------- Address------------------ - ----------- --------------------M--------- OOW .- - / Contractor's Name----------•---------------M-------r------ - ------------------ ------------------------ -------------------- Phone/. ..(9 ------ ❑ Installation will serve: Residence A Apartment House ❑ Commercial [] Trailer Court 0 Motel C] Other Number of living units: _/---- Number of bedrooms _3_ Number of baths --/.- Lot size /74 ----•-------- Water Supply: Public system R Community system El Private [:] Depth to Water Table &ft. Character of soil to a depth of 3 feet. Sand E] Gravel E] Sandy Loam El Clay Loam 0 Clay [I AdobeA Hardpan ❑ l -��( � Previous Application Made: (If yes,date--._.___.----.-----) No New Cohstru&ion: YesNo El FHA/VA: Yes E] No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) e - / &� m _f6andatio�n-Za--- ----Maferial---A - ------w----------- - --------- Septic Tank: Distance from nearest well--- Disfahc��fro Ao / .t7z? a No. of compartments___ _.1---------------Size--?7-- Liquid depth----1Capacity- ,5e.- Disposal Field; Distance from nearest well._;S'_0._/_Distance.from foundation-'_11/a---�___Distance to nearest lot line--- ... .If -,- ,I `-* 1, � ,-�, 1�-A,' of trench------�4------------------ Number �f lines- ------------ 8f'ea,ch'line e4. 70-_--.---"--.Width 9 j 1 ' A,.�..444 'J Type of filter material----- r -- ------Total length --------------- Ft --- ... Seepage Pit: Distance to nearest well---/49 ---_Distance from foundafion--AV---------Distance to nearest lot line Number of pits---.-.2--------- -__Lining mate ria ----Size: Diameter-----%?,w?_�`7-- D e p t h 07-47------------ Cesspool: Distance from nearest well-------�'_,!-----Distance from foundation-__"__________-_Lining material_____________________________________ -----------I -----------Liquid Capacity s E-1 Size: Diameter------------------ Depth.......... ----------- --------------------------gal Privy: Distance from nearest well--------I----------------------------- - ------Disfancelfrorn neares+ building------------------------------------------ ❑ ------------------------- ------------------------ ---- -- Disfancelfo nearest lot line----------------------------- ----- ------- --------------M----------------- 4 Remodeling and/or repairing (describel:------------------ --------- ------------------------------- --------------------------------------------M__-----------------M-M------------ - ---------------W-------------------------------------------------------------------------------- ----- ------------ -------------------------------------------------------------------------- --------------M-------------------- - -----------M-------I---------------------------------------------------------------------------------------------------------- ------------------------ ----------------M--------- ..........M----------------------- -- --------------------------------------------- _-&�-------------- --------------------- ---------------------------- ------------------------------------------------------------- I hereby certify that I h,ave prepared thisthat the Work will be done in accordance with San Joaquin County plication and ordinances, State laws, and rules and regiulafions-of the San Joaquin Local Health District. ---------- --------------(Owner and/or Contractor) (Signed)-------M-411 ----------------------- -------------------------------------- ------ By:-----------C_F�-------- ---4- -- - - - ---------- Title)----------------- - ---------------------- - - ---------------- !-M------ --------------------------------------------------I -(Plot plan, showing size of lot em-in"relation f 10 ion of sysf 0 wells, buildings, etc., can be placed onreverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTEDBY----- ------------ ----- ---------------------- ---------------------------mm----------- DATE---------'1-:�--e= ------ ----------------- REVIEWEDBY-------------------------- ------------M-----------------M------- ------------------------------------------------------M--- DATE---------•------ -"---------------------------------- ------ BUILDINGPERMIT ISSUED_---------------- -------- ---------------------- ---------`---------------=------------------------ DATE---------------------------A---------m---------------------- ------------------- ----------------M------------ Alterations an or recommendations:.... -- ---------- ------------------------- ------------------------------------------------ ------ ------------- ----------- --- ------ -------------------- --------------------- z -- --- ----------- -------------- - -- �, -,,-.e- ------- > - ------------- .......... zx ------ - - ---------------- ---------------- I __ - --------- ---------------- ---- --------------------------------------- --------- ------- ------------ -------- ------ -- ----------- -----------------------------------------M---- ------------------------------ FINAL INSPECTION BY:.-......... 4�X-------------- ----------M----------- Date-------- -------------------- ----------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1681 E.Hazollon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca, California Tracy,California 14 F.P.C(3.