16209 - Laserfiche WebLink

Home Browse Search

� FOR OFFICE USE: __ ______________ _ -------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ![ ------------ •-•- ................ (Complete in Duplicate) / Date Issued .....L..fJ. . ? � - _ This Permit Expires 1 Year From Date Issued ' r Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This a1p+Gplication is made in compliance with County Ordinance No. 549. lv:2 ''g J08 ADDRESS AND O ATION [�!.. ... t f — ................ Owners Name.. .__ � .....: .... hone__" f` *� Address- – Q •' Contractor's Nam .. ---------- ............°� Phone) 3 ��J Installation will sere : R si nce Apartment Ho -� p use ❑,, /Cc�merclal ❑ � Trailer Court ❑ Mote! ❑ Other ❑ Number of living units: __�_... Number of bedrooms -_' _ Number baths Lo:`slze _... -f . Water Supply: Public system ❑ Community system ❑ Privater�epth ate The j f tW Character of soil to a depth of 3 feet: $and❑ Gravel ❑ Sad y Loam Clay Loam ❑ lay ❑ Adobe❑ Hardpan ❑ f Previous Applicatlon Made: (If yes date__ ::_ y'! .'-__-) No New Construction: Yes Nos[] FHA/VA: Yes No❑ t • TYPE OF INSTALLATION AND SPECIFICATIONS: (Nol septic tank or cesspool permitted if public sew is available within 200 feet.) -P from f undation_ `_ No. of compartments------�--/ _ Material-------------------•-•-......._.__.__••_- SP tic n�k: Distance from nearest well__�_,d!s1 .Distan�e. }� � � Liquid de th_.. �_______Capacity.,. q P. / - �19 Disposal field: Distance from nearest fwell--�_1'S .....Distance from foundation__,_.__ _._._-Distance to nearest lot li Number of lines---------- ___ ________-__ Length o' each line__ d.�-_/-axIVidth of trench..- Type of filter materia f.. epA of filter material-- ---------------- 0 length______ _ V.............Seepage PIs: Distance to nearest well____._ __: mDistancefrom foundation....................Dis{ance to nearest lot _______---_ yy ❑ Number of pits_---- s_Lining kateria�l-----------------------Size: Diameter........-0 --------Depth_ �'--------------- Cess ool "" ' Distance from nearest well...............NDistance from foundation_ --- _____________.Lining maferial ❑ Size:,Diameter------------ --------- -------------Depth"+ Liquid Capacity-- -- ---- gals. t Privy: SIP Distance from nearest well _____._:..__+_-------------------------Distance from nearest uilding----------------------------------------- EI ______________________ ______________ �$ ❑ Distance to nearestalOtillne -�^+: -- • Remodeling and/or repairing (des ribs): _--__.__ ___ 1 ' `� ^" -•..............------------------------ --------------•----------------------------------------•••--•-•---------- -------------............ --------------- �b certify that I have prepared this a lication and that the work will�------------------------------••__-•_•__•_•••__--------------------------•--- -------------------------------------•-•---- - ------ •-- •------- -•------ I hereby y p p pp be done in accordance with §a*R-Joaquin County ordinances, Stat a and rule end regulations of# '�SamJoaquin~Local Health District. '(Signed)-- TM ------ :.. --------- -- --- -.: ---------------------------------' :. ..: (Owner en % r Canirect B • .----•-•. ••--- 0 or (Title)-----------•-•-------------------------------------------------- { • . (Piot plan showing size of lot, location of system in relataion to wells, buildings, eec can be placed on reverse side). FOR DEPARTMENTrUSE-ONLY' _77R APPLICATION ACCEPTED BY-------- _____________ DATE______ -----:--------------------- r gr REVIEWEDBY------------------------------------------------------------------- -----------------------------------------------••--------- DATE------- -••-----•------------•-------•------------------ -__ SSUED -•--------------- ---:-:------.... ---.._.._ DATE---- BUILDING PERMIT I _ — ------------- Alteratebr�s and/or atom ondaiion :_. f- ........ -- ----- ---•-----....... __.T, ------- . -... �------------�U rQ ._. �' i Oft_ _ A..I ---kot�nl 1_on ---------------- rerr- --------------------------------- ---------- -- ------- _ -------------------------------------------- ------------- r `.. ' -------- --------------------- FINAL `NSP N B _------ ---- Date ... s SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Strut 300 West Oak Street , 124 Sycamore Street 205 west 9th Street �1 i f�d� Stockton,California Lodi,California Manteca,California Tracy,California E$ 9 REVISED 6.59 2M 5-61 ATLAS