20436 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: `" i -------------- -------------- ------------ -- --- APPLICATION FOR SANITATION PERMIT Permit No. ��= ---- ------------------ ------ (Complete in Dup}icate) Date Issued �-_lr _r�� ----------- ------------------ This Permit Expires 1 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 descried. This app I ication is ade i ;orr}�li nc with County Ordinance No. 549. J kDDRESS N ?. . ATION �� 1 _01,4e& 0.f ��Y ----------------77; � Owner's Name- -------- Phone_ I t1 Address-------.-_------------ - - � �� Tp - ,��s�' � . _.6- ._.64? Contractor's Name_____:•_- ---- ---- � j��r 1 ------------ Phon . f Installation will serve: Residence ®-'A-partment House ❑ Commercial E] Trailer Court :] Motel E] Other E] Number of living units: __1____ Number of bedrooms _T__- Number of baths R1_._ Lot size -_-_-Aax-----------•------- Water Supply: Public system ❑ Community system ❑ Private oiflepth'•to Water Table/0- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam. Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date----.............._1 No [•}r"New Construction: Yes ❑ No [ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: _ (No septic tank or cesspool permitted if public sewer is available within 200 feet.) � � . Septic Tank- Distance from nearest well_______--__..__Dista nce from au I., n-_-______-_-'.___-.Material..._ __-___-_---------------------------• . [] No. of compartments----- ---------k--------.Size--------------------------------Liquid depth-------""""" N_Capacity------------------------ Disposal ------- ------------Disposal Field: Distance from nearest well e, Q---_.Distance from foundation_-_-�?a-:'--.-.Distance to nearest lot line_S..__._____ 4 Number of {fines___.-__/_______ _______________L' ngth of each line___-_1B0 �- '.Width of trench-.-� `-------------- {� • Type of filter matena3___��_��!�L1C'�---Depth of filter materfaL__��--------------Total length _______________________________________ Seepage Pit: Distance to nearest:well----------------------Distance from foundation___ ...__________- istan'ece oto nearest lot line__-_________----_ U. � .�� Number of pits-------�----�- Lining material------------- ------Size: Diameter--- • ---�-----------Depth.-------------------------------- El �.,._ _...,__ I Cesspool: D-stance from nearest well__J_____________Distance from foundation__.._.-----------._.Lining material__.-_________._- _________-__,__ ❑ Size: Diameter ---- - - ------ Depth LiguidsCapacity gales-V __ - - „F- ; -^- �- Distance from nearestzbuildin ----------------- ------ a Distance•from nearest well -- --- -------------------- - ) g- ❑ Distance to nearest lot line- --- ------------- ''r-------------------- --------`----- T' '1 � ------------•----- Remodeling and/or repairing (describe):-___- .------ ----- --= r R- ---------------------------------" ------------------ r ''� ------------"4�!{ ----------------- -------------- = 1. ,rr - "-'a-- ----------- I=== =r:. i It- --------- --------------------------------=--- -------------------------------------:; -� -- t= :: . I hereby certify that I have prepared this application and'that'fhe—work-w_ill be done in accordance withCLSan'Joaquln County ordinances, State laws, and rules regu{ations of the Salt J qui Local Health District, t �9 l m�/-s' � . (Signed)-----------------� - 4 ---/ - ..... _ /��m _ = --- Own and/or Contractor) -ocat' n of'system in relation to wells, buildings, etc, can bei pla f , BY e (Plat plan, showing size of lot, locat" _ „g.. S,_ ,�- _ tail on reverse side). 4 [ ' FOR DEPARTMENT USE ONLY { APPLICATION ACCEPTED BY ( DATE----- ------------------- --------------------------------- REVIEWED -- ------- -------------------- REVIEWED BY - --- ------ DATE----------------------------------------------------------- BUILDING PERMIT ISSUED---A--------- ------i. - - DATE - = Alterations and/or recommendations:---- - -•--- •- - - ---•-------------------------------------------•- --------- --- . --------------------------------------- ------------------------- -------- F1NAL INSPECTION BY:...... --� " `--�- Date---------:-- ----------------- s SAN JOAQUIN LOCAL HEALTH DISTRICT r 1601 Ha:ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street ' Stockton,California Lodi,California Manteca,California Tracy,California P.P.po.