21005 - Laserfiche WebLink

Home Browse Search

4 FOR OFFICE USE: '- - ----------- --------2--- -�- APPLICATION FOR -SANITATION PERMIT Permit No. ��s _` --------------------------- ;------- ------------- _ --------------------------------------------------------- (Complete in Duplicate) 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 rdinance No. 549,9, JOB ADDRESS A CATIONOZ_F-�'.2,.__ ._ ---I��C ._. -------_--- . x4.97 � `� ( Owner's Name Phone �_ct_� �. Address = �_ ------- -- - ------ Q� Contractors Name_._�__�__�__ __ __ �'__ ••t1 __________ _____ _ �!"c- ._ Phone _.: . _ ! -- Installation will serve: Residence Apartment House ❑ ommercial ❑ . ailer Court ❑ Motel ❑ Other ❑ k Number of living units: Number of bedrooms Number of baths 2<'Lot size ____ !5F .a-----�e<= ---- - Wafer Supply: Pub Community system ❑ Private ❑ Depth to Water Table _______ ft. �+. "y — _ Characfer of soil to ail depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ y`❑Adobe a�dpan ❑ Previous Application iMade: [If yes,date '`V'�.._..] No ❑ New Construction: Yes No ❑ R#Oay'VA: Yes �o ❑ TYPE OF INSTALLATION-AND*SPECIFICATIONS: (No septic faA or cesspool permitfed'ifpublic•se er is available_ within 200 feet,). P � Septic Tank: Distance from nearest well_ Disf�ance fr�' four�tion---J_ 1__.__Material--- _. _ _ ------.-`w. ' N'o. of compartments::_�11� ---Size _�� _yv �p_3Liquid depth.�a��__._,____._Capacity_f F�:Q� ' -M Disposal Field: Distance from,neares� weli__fZl-—1 istance from founU ation _ ,-6,,W9,to nearest lot line-----�._-_,,�� �'" 1- Gf, doh— t u i - I i umber of lines_______ _ ______ ______ ____Length of each lin�_�`�_'_�_"_k_ __ _A i of french.____.w��____:__.________ Type of filter material_ ___ �wD.egpth of filer material 'A�.!--------;Total length___-____- Roo�_-___ _ - Seepage Pit: Distance-fo-.-earest °ell pistante'e from—foundation_________-`r� ____:.Distance to nearest lot line-_.__�___ -: ❑ �tuber oftpits - --_--_-- -03-Lining mate�r;�aL__________________ Size: D,i�eter___�_-_-- --------De th------------- _ _-� -�-,� N - max_.-«.0V*6r p Disfance from foundation.._.._.._---- Lining material------------------------- -- :-. Cesspool: Distance from nearest w --------------` Size: m . r 'r�D e th---------------- %S- Liquid Capacity-... 1 �9a�ls ._ _ .--------: . Priv D,stance from,nearet ,welL ------------------------------------------------Distance from nearest building ' ❑ Distance to nearest' tt line------ - ---- i Remodeling and/or repairing (describe);__--_-" -------------------- __________________ �----- --------------•----------------------- •-�-------- -------------------- ----- ------------------------•------ `_ --- ------------------- --------------- - ---- - ------------------------------------ -------------------------------------------------------------------------------- --------------_---_------------------------ --------------------- ----------- ' ----------------- ------------- - 0 ordinances, State laws rules and regulations of the San Joaquin Locale_ - I hereby certify fha I have prepared this application and that the work will be done in accordance with San Joaquin Counfy Health Di's#rict. n.,a �` ��c EpTIC � (Signed)--------------- ---- ; ------ - - Con,ractor) rA BY:B9j5-E.11Ainer_Ave.,----Ho.& 3B41 (Title)--------------------------------------- - -- -------- (Plot plan, showing size of lot, location of system in relafion to we , buildings, etc. can be placed on reverse side). _ FOR DEPARTM NT USE ONLY APPLICATION ACCEPTED BY N-^'w_--- -- - -X110 ------------------------ ------------------- DATE7:X- -,..' _.,w...��_... -71 REVIEWEDBY--------------------------------- ------------------------------------------------- ----------------------------------------- DATE------ ----------------------- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------ --------------- DATE--------- - ----- Alterations and/or recommendations--- ------ -------------------------------------------------------------------------------------------------------•---•-------•-----------------•------------- ------------------•------------•--------------------------------- ---- ----------------------------- --------------------- --------- ----•------------------------- ---------------------------------------------- ---------- ----------111X-11X1--------------------------------------------------------------------- ----------------- ---------------------------------------------------------------------------------- --------------------------------------------------- ---------------- ------- - .. • ------------------r`---------------------------------------------.-.- ------------------------------------------------------------- - •------------------------------- ---11X1-- 111 X--11X111X1-- V - • --------------- - ------111X----11X1-- - --• ----------------11X1-- -------------------- --------------------------- 1 1X1-111X--111X-- -------11X1-- ------------------------------------------------ ".?V -- --------------------------- Date cY — 66, 6 FINAL INSPECTION BY:. - - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxtrlton Ave. ? 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,Californ a Lodi,California Manteca,California Tracy,California f.P.CC.