6264 - Laserfiche WebLink

Home Browse Search

I I S 1 APPLICATION FOR SANITATION PERMIT -Permit No. (Complete in Duplicate) 'S- � Date Issued �Applicakion 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 Ordinence No: 549. �. Q JOB ADDRESS AND LOGATI N....... ...:..�?- ----------•- C}__ �_�- __ ----� #,�---- -----------_----------------- Z, ---- ' Owner's Name..:.1 { = i _ .F1 :_ �- Phone..- Address �� -fir+. _ „�. - 7------- ---------- y •-a- ` ----1 -• = - r�- Contractor s Name------�-• ---•• ----- ��•--•- - -----••. r•.-�::�3---�-------------------------•------------.._.._. Phone----------------•------------------- Installation - -Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ t'Number of living units: ___ _,_ Number of bedrooms ---2-. Number of baths -__1___ Lot size ___/ ........X---—-- ----.-_ Water'Supply: :Public system 0 Community system ❑ Private 0,. Depth to Water Table -------- ft.-,- -3 of soil to a depth of 3-fee4:t.'-Sand-I]---Gravel-3 -S'andy L Z-5n'. —Cia" Loam-EI—Clay❑ Adobe [;M Hardpan ❑ Previous Application Made: Yes ❑ No J New Construction: Yes 0 No [� TYPE ,,OF:-INSTALLATION AND'SPECIFICATIONS:.' l ( pcesspool permitted if public sewer is available within 200 feet.) k I Tank:- Distance fromn No septic fan :or p � •nearest well_-_-� Distance frbrri ---.... 5e tic- No. of com Artments__ �s ance from folundationq id depth_-- --- Capacity 9d�--_---_-- i � p r >r Disposal Field: Distance faro nearest well .._ ��+ Distance to nearest lot YP � tenp th of each hne___`------- Width of -rich _14, ----------- t T ie or filrter material__ J De gh of filter material-- ---- - ---- --Total length--------fQ -.__-____--__-- ------ um er•-o i. e $ee a e Piti Distance tG ne:•, „� .M a p ;g crest well t pistance from foundation___________________.D�stance to nearest lot line____-__-________- Number of, its_ __Linin material___ _ _______________Size: Diameter----- ")_ De th-----------___:___-- Cessp Distance from nearest well Distance from foundation____ ___________ .Linin material- ------------------------------------ ❑oo 1 . g Size: Diameter-- --------- ------------------:.Depth----------- ---Liquid Capacity---------------------I---------gals. Privy Distance fom nearest well-'--.-------- .. ____.__-_Distance'from nearest building ___________ FT Distance to neai•estriot line -- - a Remo8eling6nd/or repairing '`describe)____________________ '� ___ e -----•--- ••------- ). ---- •--------------- - _____________________________•:__-____-____--__--_--------.____._.«_-............................-------...............--.........................................:-------..-____________:_______________ __________--__ I hereb.':cerF y That I have-prepared this.application-and that the work will -be done,in accordance with San,Joaquin County ordinances,;St fe aws, and rules and regulations of the:`San Joaquin local Health District. Si ned ---- „d1............ `_--------___ __-------_------------------------------------------------Owner and/or Contractor ey t- .=x. a '; r �f -- ... -• --- '(Title}------- - -------------------- (Plot plan;"showing-size of;lot, location bf,system in relation tools, buildings, etc., can be placed on reverse side). . .,.. .�. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY__ --- ------ ------------------- ...................-------------- DATE REVLE/VED BY -- - -- t ------ - ---------------------------------------------------------------------------- DATE QjN BUiI_DING 'PERMI,T'' ISSUED: --------------------------------------------------------------- --. . ---- --------- DATE--------- p -•--------------------------a l-----,-- Alterations-and/or-re,commeinda,tions-------------•-------- ------------------------------..........................-------------------------------------------------------------- ................. FINAL `INSPECTION ------------------------------ Date---------------------------------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street � Stockton, California Lodi, California Manteca, California Tracy, California Es-9-2M 145446 ATWOoo 12.54