22093 - Laserfiche WebLink

Home Browse Search

=FORK OFFICE USE: ..---------- ------------------------- q APPLICATION FOR SANITATION PERMIT Permit No. ------------------------ ------ ------------- ......:.........................•------- -------- -- (Complete-in Duplicate Date Issued -----------.------------ ..-_.-------------------------- This Permit Expires 1 Year From 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------ 1123-0. - -ulvti v-------R '--- .......-------------------------- - - ---=---=-------- _ A 1Owner's Name-------------- Phone _-_ Address------------_-----------�6-_.Ra _.Is--------� C-Q ry - M------------.-/Ir1TC1119 ------ --•---•-- -- ------------------------------------------- Contractor's Name------ ------ 6Q_R&.(_ rte._:__-x:— t i pp Installation will serve: Residence Apartment House ❑ Commercial �❑ Trailer ICourt ❑ Motel ❑ Other ❑ Number of livingunits_f._�-__ Number of bedroomsS---- t=� . . ._._ Number of baths --/-- Lot size ---19-CA-- ---�-(-7 ------------------ -__-- Water Supply: Public system❑ Corimmunity system El Private Depth to Watei"Table _ _ - ft Character of soil to a depth of 3 feet- Sand ["`Gravel;❑ Sandy Loam❑ Clay Loa�❑ Clay E] Adobe ❑ Hardpan L] Previous Application Made: (I yes,date__..._.._.,..._--- } No New Construction: es i No FHA/VA: Yes 0--'No E] TYPE OF INSTALLATION-AND SPECI.FICATlON5:_. f (No septic tank or cesspool permitted if public sewer is available within•.20.0-feet,) Septic nk: Distance from nearest well______ Dis}ante,from foundation""�f Maternal _--.-__ p i 0- e 15 No. of compartments-__�---_. _. Size__ Q X ._ Liquid de fh__ 2-O - - ----- � `�--------- ----- ------- -- q P. I--��.------CapacltY--�- �---• , Disposal Id: Distance from nearest wel€__S7.0-----Distance-from foundation___r.-_ _ �____.___._.Distance'to nearest lot line___._�J•__________2100, i i r e r { Number of lines__.._.________ ._____Length of each line_-_ .__:.__r_ _:_.Width of trench_.rte' ______________ Yp --.---.---- Depth of filter material---.-_P?.._'_.:--.Total length----.-- ----�`�--------------------- Seepage ---------------- T e of filter material__. ___De t See a e Pit: Distance to nearest well...-_._=____._. _ Dista /-- p g _ ___Distance from foundation_______. =_____.Distance tonearest lot line____..___._._.. ❑ Number of pits--- -•--------- -_--Lining materia'1-" -� --�"""_ Size: Diameter------•"----------?._.Depth--------------------------------- (� Cesspool: Distance from nearest well _____E i_-------Distance from foundation.__ ---- ..Lining material-. ----------------------------------- ❑ Size: Diameter- -- -------------- ----------------Depth--- ---- ----- -------- �-k---------..Liquid Capacity- ------------------------- gals, Privy: Distance from nearest well ._. _.f------------------______________________Distance from nearest building..__._______,____-:________._ ❑ Distance to nearest lot line ..`__s....__ CA' t Remodeling and/or repairing (describe):_------- •-- -------- --- - ----------------------------------y--------------- --------- --------------------------------------------------- I hereby certify that I have prepared this application and that.the work:.will_be done in accordance with San Joaquin County ordinances, to la , and ules and regui ions`of the San Joaquin Local Health District. t i (Signed)_ -.=_- -- .. ............. -----------------------(Owner and/or Contractor) r s . .• v _. gY ---------------- --- — - - _(Title ---- - ----- ...........- +. - - (Plot plan., showing size,of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side)., I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY___..�. ___ �, ___ ._. - �R'f __._ PATE__ _ :-. -- , ---------- -------- ------ ----- --�------------------------ REVIEWEDBY------------------------------------------- ------------ ----------------- -------------- - ------- DATE------------------------------------ BUILDING ------------- ------ - - - - - - -- --------------------------------- BUILDING PERMIT ISSUED -- ' #. ------ ----------------- ------------------------ DATE----------------------- - Alterations and/or recommendations:------------- -- 4 '------_- ------------ -------------------------------- ----------•--•------- ----- - ---------------------------------------------------- ------------------------ - ----- ---------------- ------ ------ ------ --------•.._ `, �i-- - tT J I - --------------------- -------------- -- - ----------- ----- - ------------ . ✓ ..................... - -- --- ---------------- -- ........... -------------- -------------- .......... ----------------------------- FINAL INSPECTI _ _ Qhd--I? -" Date.. SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,Callfornfa Lodi. California Manteca,California Tracy, California E.H.9 2M 1-67 Vanguard Press