22194 - Laserfiche WebLink

Home Browse Search

rvK u!-rlC,t ubt: --------- -- ---- �sfs'4 /1t_Vv .. APPLICATION FOR SANITATION PERMIT Permit No. .. - !__�� (Complefe-in Duplicate) '--------- ----- ------- ------------- -- -- This Permit Ex ices 1 Year From Date Issued Date Issued .�_-14� Application is hereby made to the San Joaquin Local Health District for a permit to construct and install th work herein described. This application is made in compliance with my Ordinance No. 549. JOB ADDRESS AND LOCATION_��__'/1 C � �" -�, /,E - - /!c._ � �� de ry Owner's Name__,je/ 4!' 2. Address 1 ._-. --- ------ Phone--h-•--- - Contractor's Name----"/a1C'- �G-y¢ S � 1�// f ry '40 / lr --- -�---- --- ------------ Phone -------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other. �,; Number of living °" �„ �A"� units:/ .---- Number of bedrooms _'2—Number of baths /.-._ Lot size -_. -. __ Water Supply: Public system Communit System Y y ❑ Private.El Depth to Water Table ------ - ft Character of soil to a depth o 3 feet• 'Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam 0 Clay Adobe❑ Hardpan ❑�* Previous Application Made: •(If yes;date:_:.._.N._.__--... ] No �' New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if publicsewer is available within 200 feet.) Sept Tank: Distance from nearest well,. _ -____ Dista ce fro fo ndation /y . No. of compartments--.__--_ Size. ]�_�" -----.Mate a! "-�_." =._.- = = Liquid depth-__-4L = Capacity._ ----- Disposal Field: Distance from nearest well - ._-_61slance from foundation--l�____ .........Distance to nearest lot)ine---.---- . Number of lines _-.--_ Length of each line-- _47-0 Width of trench Type of filter material----- dr • - -------•--- t' -_--Depth of filter material__-[ _____.-. '_Total length------_ �_ si -------•----- Seepage Pit: Distance to nearest well---- ...._____________Distance from foundafion_---..----_-----.Distance to nearest lot line-----_---___-___- ` ❑ Number of pits.-- ----- -------------- material--------------------- Size: Diameter Distance from nearest well ---------------- r f _ Distanc`etf;om�foundation_----_------- Lining material- --------------------------------- Liquid _- ___..___ ------ :Srze: ,Diameter- -- ---- - ----- ---- ---- ----Depths----- ------- -------- -------- ---- Li uid Capacity--. gals. Priv � � � _ _ q P Y- ---- --------------------- Y: Distance from nearest well------------- ___----_ ---------Distance from nearest building Distance to nearest lot'line_.---------------------- g--- -------------- -----=----- Remodeling and/or repairing (descr;be):___- ----•- ----- --------- --- ---------- ------------------------ - ------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rulend regulations of the San Joaquin Local Health District. (Signed)----- ° - -- --------- -I ---- - ---- -------- ------- --------- -------- •---- -- ----- -(Owner rtd/ar Contractor) By:-------------------------------- ----- _ } -- - '(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FO EPARTMEN USE ONLY APPLICATION ACCEPTED BY.-. � ----, - ------- REVIEWED BY ----- ------- - DATE- ,.. f DATEBUILDING PERMIT ISSUED-------- -- ------------------- _Alteratio ------- ------ DATE----.-.-.- -------------- enons:. ---- ---------------------------- ----------- - .--------.-- ---- - - - -- - ------ 4 FINAL INSPECTION BY:-------- ...... - ------ Date_.-- ---------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelton Ave. 300 West Oak Street -� Stockton,California24 Sycamore streetornia Lodi. California 20.5 West 9th street Manteca,California E.H.9 2!N I-b7 Vong�prd Press Tracy,California