21513 - Laserfiche WebLink

Home Browse Search

----------'----FOROFFICE�U- E--- i - - -- -- ------ - - - ------------------ --------- �_ ��__ ---------- APPLICATIOW FOR-SANITATION PERMIT Permit No. .��.�-.--------_--- -- -- ---- l..:„, Date Issued -� — (Complete in Duplicate} 3_17 -------------- - ----------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for —fes—f 7 PP Y q per-mit to..consruct and install t "work herein described. This application is made in compliance with County Ordinance No. 549. lrW JOB ADDRESS AND LOCATION/t//,” G�r ( - -G!, . ' ------ Owner's Name------ •e1/X-----... ` f -----F-�----i-•-----%---7---` 4 .. Pone- -------------------------- Address -----•-•-------------•--- Address----••--�,!._---- Contractor's Name-------,ll� .' `� f�T--------------------------------'---------------- Installation will serve: Residence 2T---Apartment House ❑ Commercial ❑ Trailer 'Court ❑ Motel ❑ Other ❑ Number of living units: /---- Number of bedrooms _ Number of baths -1 Lot size ..__.lG G ....._ ----------- _.... w, a,cC .�........r------------- Water Supply: Publics stem epth'to Water Table -------- ft. y ❑ Community system ❑ Private Character of ;oi�io.� --F j__j -�iar L_j —� ua U r raruNarr Li' Previous Application Made: (If yes,date-- -----------) No New Construction: Yes g?"No ❑ FHA/VA: Yes K4—No L l TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ` Septic Tank: Distance from nearest well--4?------Distance fr r i foundation I. ----------Matelial. / �-�-��..� _.___---- ®�' No. of compartments____ ----------------Size��g-Y_�, -Liquid depth__-�-_v.�_.._______,C apacity..gr94*-F----- ,�yy s Disposal Field: Distance from nearest well-:lW- -._.Distance from foundation,,?99_ __.Distance to nearest lot line.,;!�'---_-___-- ®� Number of lines____ _____ ______ ___.__,Length of each line,>Qi�__--_ r— ---Width of trench-�----_---`________________ ' Type of filter materi;� Depth of filter material---et�-- Total length--/`-2C9------------------------ Seepage Pit: Distance to nearest well.-.__--.--------._.--"Distance from foundation--------------------Distance to nearest lot line----------------- El Number of Pits----------------------Lining material-_. ------------Size: Diameter-----------------------Depth---------------------------------- Cesspool: Distance from nearest well--------- Distance from foundation--------------------Lining material-----.--_---.---------_-.__---_-_ ❑ Size: Diameter--------------------------- ----------Depth------------------:-------------------------- r----Liquid Capacity----------------------------gals. Privy: Di'tance.from nearest well__----------------------------------------- Distance.from.nearest building--:--_..-_--..-__---__----__-______-_.-_. ❑ Distance to nearest;lot line- ------------ -----------------------------------------•---------------------------------------------------------------------------------- Remodeling_a d/ r repairing_(describe :---t-__.._ ---5 __- - ----5----�/ ------- ----/ Qfl�� 6 ._ k __ _ __ __ _ _ _ __________________________________`-____....-...----.-._______----___-----_--_-------_---.-___-_..--_.--______-----------_-_-----____-----____----___.-___.------_-------- 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 rules and regulations of the San Joaquin Local Health District. - l-_ _t - t (Signed? ��f '� : ��or Contrectorl ---- By: - ---5------------------------ 1 - .... (Plot plan, showing size of lot, location of system in r ion to wells,'buildings, etc.,,can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--_.-_.____------------------------------------ - ____ --- ---- ------------------------- DATE---.;Z---'..-7-,-3----- --rj----------- REVIEWEDBY---------------------------------------------- -----------------`---:=- ------------------------ --- -------------------------- DATE------------------------; ----. . BUILDING PERMIT ISSUED--------------------------------------'� =-----------------------------=---------:-------------- DATE------ ---------------------------= Alterations and/or recommendations------------- -- -----------------------------------------------------------•------- -----------------------------------------------------------------•----------------------------------------•----------•--------• ---------------•---------- t -------------------------- ------------------• ----- ------------------------------------•----------------------------_-•------------------------------------------------------------------------------------------ --------------------------------------------------------------------------------------- FINAL INSPECTION BY------ - ----- ---- itl� -------- Date-- -�l---,?73. . SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stackfon,California Lodi,California Manteca,California Tracy,California cs a pcvisea e•ss a», �••sa f.a.co.