16210 - Laserfiche WebLink

Home Browse Search

-- - rc�K FESE USE: . G11J �/ -- 4_`�---- APPLICATION FOR SANITATION PERMIT Permit No. .l�- - ----- --- -------- --------- ---- -------------- ---- -- (Complete in Duplicate) ., ------------------------------------------ -------------- This Permit ExIoires 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 N . 549. 4 // t JOB ADDRESS AN OCA ION___--.-�- � _ �.-L Owner's Name---- ` Address ----- --------:---- one----------------------------------- -----•------•------------ Contractor's Name--- - a---_--- � -----------------------------------------••---------- --------------- ----------------------------------- Installation ------------.. -_ - Phone------------------------------------ Number will serve: Residence .Apartment Nouse Commerc-ia1 ❑ Trailer Court ❑ Motel �... _,q�._Commercial .�Number of living units: ___(,_Number of bedrooms ❑ Other ❑ 1 . - Number of baths __� Lot'size ___/49411—llqr Water Su Publics stem. �� PPIY� y t ommuriity system ❑ Private ❑ Depth to Wafer,Table45-1,t. Character of soil fo a depth of 3 feet: Sand ❑ Gravel ❑ Sand am ❑ C1ay.Loam ❑ Cla ❑' Adobe ar pan Previous Application Made: (If yes,date---_-------_________) No New Consfruction: Yes TYPE OF INSTALLATION AND SPECIFICATIONS: '� ❑ FHA/VA: Yes -(No septic tank or cesspool permitted if public sewer is;available within 200 feet.) :,� -, - Septic Tank: Distance from nearest-well____ p - Distance.from foundation -- ___--.Material_.��-. rJ C r 4 - ----------- ---6x--1r/V-No. of compartments.----`�„---------------Size-_-- � -•- u� T1 . Liquid doth__-/-.!.---- . 'Capacity_._ Disposal, Meld: Distance from nearest well _-----Distance from foundatror -------------Distance to nearest lot Number of lines_ ------------ i.-/__ -----Length of each line___--7xS+f__7 ---1R/id}h of trenchc�-- s Yp / �. T e.of filter material.____/9--__.-__1-"_ Depth of filter material')-9 _- i Tota! length ---------------------- Seeps Pit: Distance to nearest well----�_------ :Distance from foundation O _________..Distance to nearest lot line- Number of pits._ __ _ ------Lining Lining material_-`�'P-C-ll---Size: Diameter -------- Cesspool: Distance from nearest wail________________ Distance from fount}ation_____._.__________.Lining material------_______-.__._.___._- ❑ Size: Diameter I--------------- --------------Depth------------------= -- Liquid Capacity-. --------•- � ��-� ---- --- - --------- -- G ------ -----�--- --------gals. Privy: _ Distance from i earesf well____________ _____ '"" -- - _______%1-_______________Distance from nearest building.___.___----_______-___- _ El Distance to nearest lot line_-- -� -------------- Remodeling and/or repairing fdescriBj)_____ ____ --- - - - --------- - ---------------- = --------------------- - ------------------------------------•----•----------------------------------- -------------------------------- . .;•._.. .. _________________________________ ----------------------- -------------------- _____=Y______.-__.___-_-_______.__.__._____.______.__._._______..._-______.____ I hereby cer+if t 1 have pr red this application and that the work will be done in accordance with San Joaquin County m✓ ordinances, State I s d rule n _reulapons-of. fhe San Joaquin Local Health District. (Signed)---- ------- D t--------- t By:----------------------- I -- _ /111 - -(Owner and/or Contractor) - ------------------- - 64 Tite)_-- ---- -(Plot plan, showing size of I ocation of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - -= �ATE �^ Y4 1 - ------------------------------------------------------------ ` ------ VIEWED 8Y - -------------------------- ---- --------------------- --------- -------------------------------------- DATE -------------------------- '��► BUILDING PERMIT ISSUED------------------------ DATE Alterations and/or recommendations:__.- ,l .-s---_- ___ :�F- : ------------ ------------------------- ------ --- . -------- _...- ----- ------- ----- FINAL INSPECTI011�.----------- Da S JOAQUIN ,,CAL HEALTH DISTRICT 1401 E.Hazelton Ave. 300 West Oak street 12~Sycamore Sfr"t 205 West 9th Street Stockton,CaftFornia Lodi Galifornra �q i� 11. L r' J, Man}cci,Califo�-\ rnia Tracy.California ES 9 REVISED B-59 31.4 3-'63 i,MCU. Y