18313 - Laserfiche WebLink

Home Browse Search

FOR OFFICE.USE ----------- -- : S4 Permit 1...��..._.._ APPLICATION FOR SANITATION- PER IT ------------------------ --------- --- ----------------- (Complete in Duplicate) ' . /�_S` --.---_.-..__ This Permit Expires 1 Year From Date Issued Date issued/_ - 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::---!,;�--7j_,. ------- ----------------------------------------'---------- Owner's Name------:a2AY _ - _e. ------------------ Phone-------==--•------------------------ kf Address--------- 7 3 5v�7 ',e�i�,�-------G 1 ---------------- --- Contractor's Name------------ ------_��✓-�y'-!;�n------------------------------------------------------------------ - ------------------------------ ------------ Phone---------....__.--------•-•-------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel.❑ Other ❑ r_ 1 Number of living units: -------- Number of bedrooms _�` . Number of'baths -------- Lot size _..__�C ___.,,'_.-.�r --------------------_-___ Water Supply: Public system K q;Communi+y system ❑ 'Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand E] Gravel ElSandy Loam [❑ Clay Loam E] Clay ElAdobe E] Hardpan ❑ Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes ❑ No E] FHA/VA: Yes [INo [I TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool pdrmitted if public sewer is available within 200 feet.)/ Septic Tank: Distance from nearest Disfiance from foundat�on`"r_ --- � ____ _______________________No. of compartments----. _-a:_-----.-_- Size---_ XA.Liquid depth___ '`1X-----Capacity Disposal Field: Distance from nearest well,4)M,Gr__Distance from foundation-------/C2_--___.Distance to nearest lot line.__._.__.__ q �J Number of lines_------ __-�----.-.--_--...-.Length of each line_f f____e�.__J/_.._.Width of trench.--_->� ----------- Type of filter material ----�Lt-De th of filter material_______ _._..__Total length____f_r�---___________________ - s TYP r -- P ��-- ._ O Seepage Pit: Distance to nearest'well---.-_-_.............Distance from foundation-------------------.Distance to nearest lot line-----,----------- ❑ Numberlof,pits---------------------=Lining material-----------------------Size: Diameter----------------- --Depth---------- -=:- ----- Cesspool: Distance from near ' estwell--- -----------Distance from foundation----------------...Lining material------------------------- 171 ._.--_..--------_ ----__❑ Size: Diameter----------==--------------------------Depth------- ---------------- -----------------•--------Liquid Capacity -----------------------gals Y _ .. i, Privy: Distance from nearest well-------------_----------------------------------Distance from nearest buJding----------------------------- ❑ ------------�---------------- ------- ----- - ----------- ------------------------------------------------ Distance to nearest'lot line__---- is I �lffl.�.rJ - F Remodeling and/or repairing (describe)•------..1�1. .-------.— ��• • !, ------------------------------------------------------------------•-------------------- ---------------•---------------------------------------------------------------------------------------- -----------------`-�--.,�..� ------------------- - - Y P. P Pp-1-i-c- _ A {Ihereb c9__r__f_ify_ that I have' re ared this a ationand that the work will be done in accordance with San Joaquin County F ordinances, State ws, and rules and regulations of the San Joaquin Local Health District. {Signed) -- . . .. '- `' (Owner and/or Contractor) I +� !3 3 ct Title (Plot plan, showing size of lot, location of system in relation to wells, buildings, e+c., can be laced on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED SY----' '----------------------------------------------------------------------- DATE.-/.2'/,5 REVIEWEDBy------------------ ------r-------- ---------------------------------------- ----------------------------------------------- DATE---------------------------------------------------------- BUILDING -- -BUILDING PERMIT ISSUED------------------------- ------------ --- ----------------'-------------" ---------------- DATE------------------------------------------------------------- Alterations and/or recommendations:-------- r -- - ------------------------------- --------'----------•-----•------------'-----------------------------_____------"""--------------------.._...-..--`---- s f�4[ -----------------------------------------------------------------------_"`__--------'--------------•----.....__-----------------------------------•--------`----------•-------------------------•---•-----------..-------- 1 - ----------------------------------------------------------------------------------------------------------------•------------------.-- ---�_--- _--------------------- FINAL INSPECTION .BY: --- Date--- s `.:' SAN JOAQUIN LOCAL HEALTH DISTRICT x 1601 E.Hazelton Ave. ..300 West Oak Street 124 Sycamore Street 205 West 4th Street 17ca Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO. ,. a