22595 - Laserfiche WebLink

Home Browse Search

1-UKVrrIC-E USE: r - --- ------------------- ------------- ----- ----------------- - -----------------------------_---..__ --------------_--------------- APPLICATION FOR-SANITATION PERMIT Permit No. -------------------- ------------------ - --------------- i Pete in Duplicate) F--------------- (Complete 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 instah the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION} __ -----4. ------- �a- ._. I, p - _17 i Owner's Name------ --------- � _ ---------------------------------- - -- .--- Phone Address---------------------VAI �---�- Oi Z . - ----------------------------------------••-•----------------......... Contractor's Name ' i ---.IRA---I' - �------------------------------------------------ Phone----------------------------------- Installation will serve: Residence Ejj/'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _..I--. Number of bedrooms __ -- Number of baths -/---- Lot size ..-- ..x--- C ..-----j __ __•_-____-- -4 Water Supply: Public system ❑ Community system ❑ Private Rrepth to Water Table - ._ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Er"TH-ardpan ❑ Previous Application Made: (If yes,date-----__ ---------) No Qr' New Construction: Yes ❑ No [ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ArrA)/gyp �. ,[No-septic.-lank or cesspool-permittedTif-pu6lic-sewerris-availa6le-within..200-fee .)-,—.,—.. ..-�.�. rr.. Septic Tank: Distance from nearest well-----------------Distance from foundatiLon-----__-----.-._.--.Material--.----__-_.---.--_-.------._ OtV en(i,sl No. of compartments------------- - ----------Size--------------:---------------- -squid depth------ Capacity -------- Disposaf Field: Distance from nearest well---i-S_y---Distance from foundation_.29---- ----Distance to nearest lot line-_-Number of lines.......... ----- -��-- --------Length of each line---------��--------------Width of.trench.... �-�--------------------------- \ ..._ Type of filter material-- 1C -—-----__Depth of filter material___tV...........Total length_---.--,_0 � Seepage Pit: Distance to 'nearest well----------------------Distanee'fro'm foundation--------------------Distance to nearest lot line----------------- 0 Number of pits----------------------Lining material---------t---------- - Size: Diameter-----------------------Depth---------------------- Cesspool: Distance from nearest well----------------Distance from foundation.--_- ------------- Lining maferial---------------- ----.- _ ❑ Size: Diameter----i ---- - Depth.-- -,--------- Liquid .Capacity ----- -- - ------------------ gals. Privy: Distance from nearest well -- Distance from`nearest buildin Distance to nearest lot°Lin ----------------------------------------- Remodeling and/or repairing (describe): -I� r '"- _ p €?,k.i,�.7i3: ---------•-------------------------------------------- ---- ------ ------------------ ----------------------------------------------•----------------------------------------------------------------------------------------------------------------- ------------- I hereby certify that l have_prepered this application*and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rru�}es and.regulations of the San Joa.qu,in Local Health-District. •(Signed) l.-<1`'��?�c� ±/I � 4�„/ ------ ---- --- -- - ---------- ------ -- ------- -._ :�By:.:-:__ ,__��_ �--=-n- �... caner and/or Contractor --- ... ---- ---{.Titlei----- d/o � _ = (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). II FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED --- -- DATE --------------------------- f-`�3��r� ----------- - ---- --- REVIEWED BY - --- I----------------- I----------- ------ DATE -------------------------------------------------------- - --------------------------- UILDING PERMIT ISSUED-_,--------------------------------------------------------- ------ DATE----------------------____-- --------------------------------------- ----------------------------------- -Alterations ------------------------------- and/or recommendations________________________--._.__ - • i i FINAL INSPECTION/BY:. Date------ ------- ... SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore street 205 West 91h Street r Stockton,California Lodi,California Manteca,California Tracy,California irf F.RCq. f