21996 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: APPLICATION JFOR SANITATION PERMIT Permit No. - ----------------- -- (Co. plete in Duplicate( _ 3D—e, j _ _--------------- ------- This Permit Expires 1 Year From Date ls%ued Date Issued --------------------- Application 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 Or iA e N 549. hit a� JOB ADDRESS AN. LOCATION C1 �' LGL ld1 I- 1'1 ' 3��a �I, Q1" T- d� 1 Owner's Name - __T-e_n_.�.. Y ---------------------- Phone Q ,/ Address------------------•---------- QfA } --- �•----V II------------------------ ---------------------------------------------------------- A C_ .T111.��t.l----------------•---------------•------•--•------------••- Contractor's Name----------�---- -D---t------- lei Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ �I t Number of livin units: _._.._ _ Number of bedrooms; Number of baths Lot size __.___ _ XQ__� 9 Water Supply: Public system ❑ Community system 1 11 Private [Depth to Water Table 6,57ft. Character of soil to a depth of 3 feet: Sand ❑ Grave ly�❑ San oam F1 Clay Loam E] Clay ❑ Adobe [f]-<rdpan C1Previous Application Made: (If yes,date---._.___,__.____) No: New Construction: Yes �KNo ❑ FHA/VA: Yes F6o�No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool Permitted if Public!se�Iher is available within 200 feet.) )j , Septic T Distance from nearest well - � --Distance from foundation_ ��. Material rias_{ � �[ No. of compartments___-- -_,_______/_p ize___3x_;_______________Liquid depth_.'/�__________Capacity__ -� 01-Disposal ed: Distance from near t well P_____�Distance from foundati�� a)_____.Distance to nearest to ir)el-S..__. �[ Number of lines____ _ __:__, ,ength of each line--- _ _ yt_ ____--Width of trench__ _ _ _ Type of filter materiaL___. _ 2__J�� epth of filter material ��_�___Total length___ I____ p ------------------------ Se page Distance to nearest well____ s ______Distanc , om f dation_��_p_________-Dist�ye to nearest lot lin Number of pits.__./_._.!._Lining m�atenal__ U ..Size: Diameter_�.3._._.____Depth____L� __.. Lpth Cess ool: Distance from nearest well________________Nstance from foundation____._._.._..___.Linin material___.________..______._________.___P 9 Size: Diameter----- -------------------------------,NN ---------- ------------ -------- -------- -------Liquid Capacity----------------------------gals. Privy: Distance from nearest well_________-____'l.� _______._ ------Distance from nearest building___-_____________________________.._. , ❑ Distance to nearest lot line----- � `P ----- (------ ------ ---- -- - -------- ------------------ (describe): -- - 401 ------------ Remodeling and/or repairing; (describe) i __ _______ I ty� �,..� y _- __ II_I____. _ __._______ _ _ p4 ` -- - -----� `-- --- --- �" I J---------------- - - - -- ': ' -- ---- ��----------------------------------- - - ----- - ---- hereby certify that I have prepared this application and f9at the work will be done in accordance with San Joaquin County ordinances, State la , a rulefarjftll tions of thetanJoaquin Local Health`District. (Signed) Gar " -------- -- -- -- ------ (Owner and/or Contractor) #g - --- -�!' ---------------- -- ---- - ----- Title .—Z-) - - ---------------- IY - ® _ (Title)-- (Plo+ plan3 shoi a of"lot loca+ion of system in rela+ion to wells, buildings, etc.i can be placed on reverse side. IIb � � FOR DE0ARTWEW10J6E ONLY I IF r II .. A'PPLICAT ON ACCEPTED BY....___._ _t_ ___._ _. _ ,_ _ " _' _ - ----,D"ATE---------- -_----- -- - REVIEWEDBY------------------------(--------------------------------------------------�-- . _ ) I DATE---- ------------"' � I -- �------..DATE ---- BUILDING PERMIT ISSUED__---_____._ .__ __ . � �----------------------- "'�------.-------.------------------------ Alterations _.__ __ _____ __Alterations and/or recommenldations:_ __.. �_ ---------------) #______ _________ _______________ .:- ---------------------------------------- I . ______._.__._-___ ____ __ _ ._ '." -' ---- ---- 7p------------------- `7`---------s--------------------------------------------- -- ----- -- ----- ------- ---- ------_- . ��' -- -------_ --- --------- ------------------------ ------------------ - ------ ----- - ---------------------------- -------------------------------------------- ---------------------- - ---------_ -------------------- 61 FINAL INSPECTION _ BY:.______-__- - : _ AF.1,_ Date ` SAN JOAQUIN LOCA HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Streeti 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California i F.P.0 C. _ I r