20642 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: t J/_ ---------- --- ----- --- - / --- ---- -- ---------------------------------------- ---- APPLICATION FOR SANITATION PERMIT Permit No. ..: �. ��?.. --- i ----------------- (Complete in Duplicate) -------------- --- This Permit Expires 1 Year From Date Issued Date issued --- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made:in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION______._._-6�8 so. Caxd3na--,-Ave..._....S_tockton--____________________ Owner's Name-------------------RpgO__R.All .o- Phone. l�2:a$ A-7---------------- AddreAddress----------------------------------------aalm---------------------------------------- ss----------•---------------------••-•----aalm---------------------•----•--•--•------- -----------------------------------------•---•---------------- ...._.-------------------- -_------••----- * -------------- Phone ---------------------------------- Installation 66 X3841 - I Contractor's Name----------------- ' i e� Installation will serve: Residence Xj Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___ _ Number of bedrooms ___Jl_ Number of baths ______LLot size -----7,51---1_-_-90k-____- Water Supply: Public,.system El Community system El Private tj{ Depth to Water Table --60- £t. k '� Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [jXHardpan ❑ Previous Application Made: (if yes,date_-.__.._____..._.._) No ❑ New Construction: Yes ❑ No [} � FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: -(No septic tank or cesspool permitted if public sewei• is available within 200 feet.) Sceptic Tank: Distance from nearest well_________________Distance from foundation--------------------Material------------------------------------------------- E)fillsting No. of compartments--------------------------Size---------------------------- ---Liquid depth--------:- ---- Capacity----------------------- , : Disposal Field:' Distance from nearest well--------- -----Distance from foundation--------------------Distance' to nearest lot line----------------- JV E ting Number of lines-----------------------------------Length of each line-----------------------------.Width of trench----------.--- ------ �s Type of filter material-------------- ---- -Depth of filter material-------__-------------Total length------------------------------------------ Seepage Pit: Distance to nearest well----_3.201--- ----Distance from foundation----2j2_______-Distance to nearest lot line--- _:_.____.._ (e, Im Number of pits-------I------------Lining material-----Ro—,J�-------Size: Diameter------33!!---------Deptn------2-5't__________________� [ Cesspool: Distance from nearest well-__.____________Distance from foundation....................Lining material-------------------------------------- El ._.___...._.._.____.____.______❑ Size: Diameter--------------------------------------Depth--------------------------------------------------..Liquid Capacity-- ------------------- -----gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----.----------_--------------- --___._. ❑ Distance to nearest lot line---- -- ---------------------------------- ------------------------- ---------------------------------------------------------------- Remodeling ----------------------------Remodeling and/or repairing (describe):---------------------- ------------- - ----------------------------------------------------------------------------------------------••------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ I --------------------------- I hereby certify thhave prepared this application and that the work will be done in accordance with San Joaquin County t ordinances, State laws,%rrulles and regulations of the San Joaquin Local Health District. l (Signed) 2 ay 9� __. . Owner and/or Contractor By-2-910-9t-Miner 0.6• �$ ---- Title----------------- ------------ - --- - --- ---Ave.,= I 1 (Plot plan, showing size of lot, location of sys+em in relat' n to wells, build' gs, etc., can be placed on reverse side). FOR 9PARTMENT USE ONLY APPLICATION ACCEPTED BY------- ---- ------ ------------------------- ------------------ ------ -------------- DATE------s _�? _.. �------------------------ REVIEWED BY----------------------------------------------------------------- ----- ------ DATE-------- BUILDINGPERMIT ISSUED------------------------ -------------------------------------------------------------- DATE------------------------------------------= ID Alterations and/or recommendations:......W-._i(k----------=41r .------- -------------------•-------•------------------------------------------------------ --•---1------------------------------------------------------------------------------------------------------------------------------------ ---------------------------------------------------------------------------------------------------------------------------------- -------------------------------- -------------------------- •------------------------- ------------------_--------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------- ------------------------------- -------------------------------------- ---------------------------------------=-------------------------------------- -------------------------------------------------------------------------------- --------- ------------- FINAL INSPECTION BY:--------------- ................ Date__-__�--/ Y � SAN JOAQUIN LOCAL HEALTH DISTRICT I 1601 E.Hazeltort Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street t Stockton,California Lodi,California Manteca,California Tracy,California F.P.Gp-