8348 - Laserfiche WebLink

Home Browse Search

14? rI'r APPLICATION FOR SANITATION PERMIT • Q 3 'r� l� "� � Permit No. __f3-.___ ,7-.-._-____ (Complete in Duplicate) i 1 Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct, install a ork herein described. .This applicationls made in compliance with County Ordinance Na. 549. JOB ADDRESS AND LOCATION._&*:: _' Ice Owner's Name----------- 15 ------ ; �---*---- r 1 �. `f =- Phone L tAddress ----- ---------- ., Contractor's Name----- ------------------------ Phone Installation will serve: Residence �Apartment (--louse ❑ Commercial _ ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/-__ Number of bedrooms Number of baths �--__- Lot size -__ti,��+, Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table _ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy-foam❑ Clay Loam ❑ Clay ❑ Adobe ar 8� dpan ❑ Previous Application Made: Yes ❑ No �`iNew,Construction Yes ®--No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: {No septic tank or cesspool permitteif public sewer is available within200 feet.( 4 ` 1 Septic Tank: Distance-from.nearesr w;l-_)U'14-4-Disfance from foundation ---------Material a, t ' Liquid ! -----------C- a acitNo. of compartments.....�.'V ---------Size--- ----- de th_---� D;sposal Field: Distance from nearest well__)-"�;��Distance ,from foundation__ y_ -------Distance to nearest lot-line......e.� Number of lines___`_ _ �, f, -/-------—---------\_,Lengfh of each line---.--fes'• ------------Width of trench....._ 1,' Y � Type or filter matenaL_1.�--� Depfh<of'filter material------/�°�_---.Tofal length__..�----__j-�__� 0 Seep�a�g�e •Pit:- Distance to nearest well__`lC'-7s�c-Distance from foundation__-__'7n,_•_____,Distance to nearest lot line-_ �____.-- X19 Number of pits.�-.�`-_ -Lining material� '1Size: Diameter__ • Cess' ool: 4a; r Depfn- `----------------- p Distance from nearest'el___-9stance from foundation.______--_----_----Lining n material-._______________________- ............ Size: Diameter- ------------- - Depth---------- ----- -_ ----Liquid Capacity Privy: Distance from nearest well ______________ r---------------------------Distance from-nearest building-___----___-__--__------- [� Distance to nearest lot line_._ -.____ �__- --:� t ------;; --------- -----------•----•---------------- -.--- 2 -------------------- -- 'Remodeling and/or repairing (describe)--------------- - =•-•- ---- - - ``----- - 1CZ------------- __________________________________________ __ Y� ! _.----.---------------- . . ----------•----•-----•---••---------------------- _ I •-•---------•-------------------------------------••------•--------•-----`------------------••------------------------•------------•----------------------- ------------------ -------- ---------------- ------- {� --------------------------------------------- -------------------------------------------*----------------------------•--------------•------------------•-----------•----------•--------•-------------•------------------------------------------------------------- I. # I hereby certify that I have prepar'ed'-thii:applicafion endYthaf Ah work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. i(signed)-------- __..---- t, d`' l �a .�& ( or Contractor) By------------------------------------ --- �` �� (Tale) '//-/ ... - ------------------ -- -- (Plot plan, showing size of lot, lavation of system in relation wells -------------- buid�ngs, etc., can be placed on reverS+s side}. ` { FOR DEPARTMENT USE ONLY ,a 4- APPLICATION ACCEPTED BY_ ____ M ---------- DATE----- EREVIEWED BY ------------------------------------------ --- - -------- ------- -------------------------------- - `. BUILDING PERMIT ISSUED-------- --•-- l DATE ------------------------- - ?_ + ------------------------------------ ------------ ----------------- DA Alterations and/or recom ndati s:___._-.' -'� ---------------- ----- --------------- di = r f1 •� . E S_CX�k -------- --------------- -------- --_._ - . FI A�INSPECTION BY:: ` _- Da e , ik SAN JOAQUIN LOCAL.`HEALTH:DISTRICT' 130 South American Street 300 West Oak Street4f 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ,A ES-9-2M io-sz Revised W-2100