68-199 - Laserfiche WebLink

Home Browse Search

Cq FOR OFF /, �� // a �- Permit No. ---------------- �a Z'- '��---------------- ----- APPLICATION FOR SANITATION PERMIT ------ --------------------------------- - ------------- (Compfefe•in Duplicate) ...- Date-Issued �_f7_. 5 r 4, _ .----- ; -._ ---- --------- =- - ,,—:--S s e.mit Ex ices 1 Year From Date Issued„ - - ` A lication is hereby made`to the San Joaq(in cal Health Dist—ce " 9r a permit to construct and insta4l the work herein descried. f Thiispapplication is made in compliance wi County Ord • �.wr - t. - JOB ADDRESS AND LOCTION--- ------- ---. o act _ - . �__-------- -` -- -'r Phone '' ' ------ -- -•-----•- --- y- f y, ,z1 • Owner's Name �/}] r ;=r _ ,�F f�. ---I-------- ;--------- _ - J ------f._I---f------- -- - -------------•----- ------ ------- ---- ------ Address__.-------•-- - _e Phone.. Contractor's Name------------ - -- - --- ______ __ _ _________ __t-__--_- - - - - � ' Other Installation will serve: R !dance Apartment House Commercial E3.1- 0" Trailer Cour} ❑ Motel ❑ ❑,� i Number of livinnits: __ Number of bedrooms __.- ;Number of baths - -_"" Lot size _" _•- -. I Private De'th to Water Table��-' ft i Water Supply: Pu !c system ❑ Community system ❑ � p F Loam Cis Adobe �ardpan ❑ A--nay ❑ Y ❑ Q Character of soil a a depthof 3 feet- Sand ❑ Gravel_❑ Sandy loam Y /No ❑ '~ . " VA: Yes [ A New Construction: Yes'❑ No ❑ FHA/ ❑ �+ Previous Application Made: h(If yes,date-------- --------- 1 No �� 1 TYPE OF INSTALLATION AND SPECIFICATIONS: � (No septic tank or cesspool permitted if public sewer-is available within 200 feet.] _�. ..� _. D!stance from foundation. L_ _ - �_.Materia4 -.--G ?` ---- Septic Tank: Distance from nearest well - Li uid.de th..._.-_- ------- --------Capacity-------C__.___._-_ .- No. of compartments.. Size---- ------------ -------- Q p. Disposal Field: Distancefrom nearest welL�..`.�.f""!-�istance from -----------Distance to nearest tat line. -""- - Number-of lines. Length of each line-- -Width of trench. --- J r❑ Depth of filter material..--- - -_"-" -Total length------------------------------------------ Type of filter material-___"-__..__.__._-_.-" ---- Seepage Pit: • Qisfiance to nearest well_...................Qistance from foundation-..___�-_-".--.-.--Distance to nearest of !ne".___.-____"__.-. t Number of nearest - s - Lining material---------------------- Size: Diameter---------- ---------- Depth----------'---------------------- p�j 1. Cess❑ooL Distance from nearest well _______________Distance from foundation.-- -`'---- ----- Lining material-_.----------------------------------- 171 _- __-..___.___-.-_. Cesspool: ----_Li Liquid Capacity ----------gals. ❑ Size: Diameter -- - --- --- --------- --Depth----------------------- � q p Y i ` ..Distance from nearest building..--'------------------•--------, Privy: Distance from nearest well--------------- ------ 4 ------------------- ----------------------------------- ... D!sfiance�to nearest lot line_-.___.- f ------------------ Remodeling and/or repairing (deacribe):-----f ` - ---- ------ ---------------------------- �' -- --------- - ; ---- r 11 s � ¢ F h t_► �'� , = � �. --- ------------ ----------------- -------- — ------ be done I hereby certify that I.have lespandareduthis lations application the San JoaquinhLocalkHeallth District. n accordance with gg San Joaquin County ordinances, State laws, and g i ----------------..(Owner and/or Contractor) (Signed)_ --- -------------- ------- ----- gy:---------------- (Plot plan, showing size of lot, location of system in relation to welts, buildings, etc., can be placed on reverse side). OF FOR DEPAR ENT USE ONLY I APPLICATION ACCEPTED BY__. ------------=------------------- - ------- ----- - = DATE-- ;:---------------------- REVIEWED BY----- ---------------- -:---------------- -- --------- ----------------------------- --------�------- --=-------• DATE------------------------------------------ ---------• --- - DATE----- ---------- ------------------------------------- BUILDING --- -- -- --- --- --------- BUILDING PERMIT ISSUED c ISSUED------- -----�-. .:,-1--�---- --�- --.'---o-.-_-r-° G - -- � �f a a rations andor reommgndtin :...Altell ----•-- -- - -�e ,----- -�Ip _ � or R. et G.r. �GZ - ---------------- FINAL INSPECTION BY-- ------- - ---- = - Date. ANY YAQUIN LOCAL HEALTH t 124`SycaD.ISTRICT) t � t 300 West Oak Street Street �, 205 West 9eh Sireet 1601 E.Nacelfon Ave. Tracy,California Stockton,California Lodi. California Manteca,California E.H.9 2M 1-67 Vanguard Press p f.