20213 - Laserfiche WebLink

Home Browse Search

l-UK Ul-HC.E USE: ------------------ ----------------------------------- --------- - ------------------- --------- -------------- - _---- ----------- ----- -------------------------------------------------- APPLICATION-FOR-SANITATION PERMIT Permit No. ------------------------------------------------------- (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 comp)-ante with County Ordinance No. 549. MA&;T.EC#q , /'� D J,4�JOB ADDRESS AND LO I� J _ AIC _.---�-I�M P_-__:._-_[-1.D...- l----------•---------.- crK'f / � n 1 f Owner's Name t�� 7 l Phone r Address I ��' '= ---- T;Z L1 ------..... �C_R � - - - ��'rQ � ,y Contractor's Name QN ------.:.' -�'- = Phone._ Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [] Other ❑ Number of living units: -t------ Number of bedrooms _2—_ Number of baths -.l--_-- Lot size ---A_CR-EA_C-G---_----„-_------___-- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table t. Character of soil to a depth of 3 feet: Sand [Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑A Adobe ❑ Hardpan E] Previous Application Made: (If yes,date-,,--.-: __- ---A-) No New Construction: Yes ❑TNo W/1-iA/VA: Yes ❑ No E�'- TYPE OF INSTALLATION AND,SPECIFICATIONS: ja (No septic tank or cesspool permitted if-public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material______--_-----.____--_...__-.___________._____. ~ jV1pST-1,0V6Z No. of compartments---`------T-------------Sizet------------� ---- -I -------Liquid depth---------------- ---------Capacity------- --------------- Disposal Field: Distance from clearest welf____ d-_y Distance from foundation______rf ____.Distance to nearest lot line---. ...... NO E 7"i!i�� Number of lines___.___.__I______________________Length of each line_-.-_-W--_ Width of trench------- -�------- N -t- 1g .p' Type of filter material jTQ-GK-----Depth of filter material------P 7__yr Total length-------------------A6Q--------------- Seepage Pit: e Distance to nearest well.../OP---------Distance from foundation____140---.----Distan e to nearest I t line____.._--- ❑ Number�,of pits.._Ity-------Lining material__4RVC-K__- Size: Diameter-65X&5X _ Deptn_! -------------------- X. -12.ti Cesspool: Distance from nearest well-----------------Distance from foundation-_---_------------ Lining material___-. -..-__-- ❑ ;Size: Diameter------ _ ----------Depth- 1---------------------------------Liquid Capacity- -------- ---------------gals. Privy: Distance from nearest well-------------------------------------------._�--Distance from nearest building.__.__..___-_______-----_-__-__-.-.._-. ❑ Distance to nearest lot line-- ---------------------------- - - 1. Remodeling and/or repaiirnng (dostri te):,---_ ------F_K_I_ T/Aj .yM -------------------------------------------- -------------------- -----•---------------------•------- --------------------•----- - -------------------------------•-------------------•-------------------------- --------n-M-9-'------------------------- ----------------------•---•--------------------------------------- --------•--------------------------------------------•-------------------•------------------------------------------------------------------ - .- - ---------------------------------------------------------------------i-------------------------------------------------------------------------------------------------------•------------------------------------------------ I hereby certify that I have prepared this application and that +he work will be done in accordance with San Joaquin County ordinances,or�f'a laws, and rules and re s of t e San Jo quin Local Health District. (Signed] ------'---�� (Owner and/or Contractor) By----------------------------------------------- ---------------- - -------------------------------=----------4:>--------{Tiffs]- --------------------- (Plot plan, showing size of lof, location of system in relation to wells, buildings, etc., can be placed"on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .R.,.Q- ----------------- ------ ---------------------------- DATE , .."n REVIEWEDBY----------------------------------- ----------------------------- --------------------------------- ------;------ DATE BUILDING PERMIT ISSUED----------- -------------------------------------------------•----------------------- ----- ---------- DATE - Alterations and/or reeccommeendations:........7TRl=1�dCHJ�__. _.�-......P_V. ------��---------4gm--•--- ___.-__-1_TI"I E.7.V l___.____-(- �rnrJ_1_T--------------- _. _ ----. - _ ._._ .. ----_-__�' -_�----_------__-P_.__'_R____p_----..__1 __..___�-.------.____-�-_-_.-..__._.- ----------------------------------------------------------------- ----------------------- _-- _______________________ ________-_.___.--__.---___..-_-..__-.__._____.-.._____---.._-__--__._-_-.----_---_-.-_.___________.--__.__--_--..______-_-_----_-_-.__.-_-.---_----------------------------------------------------- ----------- --_._-_.___--.- .______._-_•___._-_--_--- --------------------------- --------- Upr-F7 ow-5-------MVFR�----- tU)yH0u p4ac�wn/ ----- --F� r---- -rfr-------- FINAL INSPECTION BY:..........7TR, --------------------------------- Date------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hmrelton Ave. 300 West Clak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California & Manteca,California Tracy,California ` F.P.C G.