18247 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: ► _. - � � cl-----------------��,_�-o APPLICATION FOR SANITATION PERMIT Permit No. .._____________......... -------------------- --------------------------------- (Complete in Duplicate) ---------------- This Permit Expires 1 Year From Date Issued Date Issued6_C� 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------I-61 --W._ f ------------------------------------------------•-------- '--------- `a- ---/-------------------------- --- ------------------------------------ Owner's Name--------------- --------------- ----- Phone Address------------------361---A*...-ft-h-- `_---------------------------------.-..---------------------------------------------------••------•--•----------------•------------------------ Contractor's Name______________________ --Rota---Rao-b*r---Rtwar----Se-rviEe-------------------------------------------- Phone----------------------_---------- Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _--1-Number of bedrooms 2----- Number of baths __,--_ Lot size ----6.0----x----175--------------------------------- I Wafer Supply: Public system ® Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Ciay Loam [❑ Clay ❑ Adobe Q Hardpan ❑ Previous Application Made: (If yes,date_..__..._.._...___1 Non 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-----Si11------Distance from foundation---1_C3.*-------- Material----T.e dwo-od-----------------__----. ❑C No. of compartments-----------2------------Size_3/lX5XQ-------------Liquid depth------4*---------------Capacity____8Q0---------- Disposal Field: Distance from nearest Well--x............Distance from foundation------1-Q_!----..Distance to nearest lot line----5-'---..... F1 Number of lines___.____I_____�-._..--..._-_Length of each line----9Q-*------------------Width of french._._24-n----------------------- Type of filter material_.__1-2---roCk-Depth of filter material ------L8------------Total length..__�0_0____________________________ Seepage Pit: Distance to nearesf well-----________X-------Distance from foundation------1-0---------Distanc11 to nearest lot line-__ .e.._._._ Number of pits----------1____.____Lining material._roc k Size: Diameter_.------ Depth____-..- `-�.�___ �_X_a__ Cesspool: Distance from nearest well--+--------------Distance from foundation__.._- _--.Lining material_...__._._:___.________.________ 'E ❑ Size: Diameter-----------------^ .:�--------------Depth------ --------------------------------- ----------Liquid Capacity- ----- --------- --------gals. Privy: Distance from nearest well-- ---------------------------_---------------Distance from nearest building------------------._.-._.-._------.._-_--. ❑ Distance to nearest lot line-------- ------------------------------------- ----------------------- ---------------------------------------------------- --._.-------- s 4 Remodeling and/or repairing (describe):------_:.Nd_W.__S q:k!m_ --------------_---_----------------- ---------------------------------------------------------------------------- r '{. t s ---------------------------------------------------------------I--------------_.--�-----__-_---.-----___-____-_-__.___--_-_--------_---_----_-_-----__--_--.-.._-_.-._-_--_.----___--_._--_--_-.--....._-----.-._-..____..__. { ! hereby certify that I have prepared +his aPP icatilon a d+lia+th work will'S"o a In accordance with San Joaquin County 3 ordinances, State laws, and rules and regulations-of the San Joaquin Local Health District. Si ned 130t0 OOt_e. 4 Owner and/or Contractor elYlc -------- ..._.-.._ .�.. W.- By: "` ---:.--{Title) Owner (Plot plan, showing size of to to ation of system in rela+ion wels, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- ---------------------- ------- DATE-- -= -A--r�-4-- -- REVI EWED BY------------------------------------------ ------ ------------I-- --------------------------------------------------------- DATE------------------------------------- -------------------- BUILDING PERMIT ISSUED-------------------------- ------------- ---------------- ATE._------.----- - --- ---------------- - - ---------------- Alterations and/or recommendations:_.7:i 'fr° � �== -••-•--------------------•----------••------------------- I ------------------------------•---------------------------•---------- ----------=----------------------------------------------- - ---------------- -------------------- --------------------------- -- -------------------------------------- ----------------------------------------------------- FINAL INSPECTION BY:.��_-� -_ . -. �C- ---.-. 12- —,F—� Date ---------------------------------------------- ,SAN JOAQUIN LOCAL HEALTH-�DISTRICT 'IS. i4 1401 E.Hatelton Ave. 300-'West Oak Street - . 1,2'4 Sycamore Street 205 West 91h Street . w Stockton,California Lodi,Collfornia Manteca,California Tracy,California J F.a.c o.