76-5 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ............. (Complete-in Duplicate) S- G ADate Issued This Permit Ex ires 1 Year From 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 No. 549. JOB ADDRESS D LOCATION._ ��a r1.; eG_&A - . „ _ 44 JOB Owner's Na �; . -- ------------------------------------- L.Y 1 _2._:.�_�� _ Phone_.� �Q-� �d - - Address -------- ----- ---- - -C- ---- ----�� Contractor's Name..... .._ r Y ^,-9 - = �>�'- ---- --- ----C'----�------___�_� C. --�--- .:/ __- -�--- -'•- ---- -- •--....._ Phone._ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: "!_--- Number of bedrooms A. Number. of baths-OA-Lot siie ----- ---- Water Supply: Public system ❑ Community system ❑`-P-rvate�[depth to Water Table ------ _ ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑':Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date................... 1 No ❑y�iNew Construction: Yes No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: No septic tanr cess aolk oermined if. Iic ewer is avalla'le within,200 feet. Septic Tank: Distance from nearest well.. Distance fpm foundatlon..�-_----_- Material --i�.�.4,lst.CAr0A--------------- ❑ p Q4-------- -Liquld d th Capacity No, of com artments...--_._- Size._." . - L_-T r . Disposal Field: Distance from nearest wef4 -Dista, from�foundatio _......Distance to nearest lot�,line_.� ---_- ❑ Number of lines--_-___ .©_. _..___Length of each.line.....__. .40-0-___--__--.Width of french--- j 5,� A `Type of filter material.___. �C... epth_of_filte� rr atarial "... ---------- length------ jirds 60&: _'Distance to nearest well./4.@_-_._.__Distance from foundation-14 Distance to nearest lot line_-9d.---_-. p g Size: 134e1'fleter.YX�XIQ..Depth----�0--------------------- ❑ Number of pds._. ..�_._:._____Linin material.._�_�� r ------------------- 4p_ A Distance from nearest well ................Distance from foundation---.............. ..Lining material..._.__._..__._-....._------._....._ ❑ Size: Diameter- -- -------- ----- ----------------Depth-------- - ----- ------------------ ----------------Liquid Capacity- -,---------- -------------gals. Distance from nearest well.... ..................................Distance from nearest building----------_----------------------------_. 1 Distance to nearest lot line ............................... ------------------------------------------ Remodeling ------------------------------------- -Remodeling and/or repairing (describe) ------------------------•---------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------•-------------------------------- ---------- -------------:-- ---- --- ---------------------------- -----------------------------------------------------------------"------"----------------------------------------------"------------------------------- I hereby certif hat I have prepared this application and.that the work will be done in accordance with San Joaquin County ordinances, St a s, an"r es and eg lations of the San Joaq ' Local Health District. r (Signed)-.- ----- - --------- ----------------------------.----- sem ---- -- __(O ner and/or Contractor) B - --•- �----- --------�---- _ � _.. . ..: - :- : - -------�-�-:-{Title---- - �.--�...... ,..�.•--_-��- {Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed reverse side}. A FOR DEPARTMENT USE ONLY APPLICATION ACCEPTEDBY ------------------------ DATE.- --- 2-7-2-e - --------------------------- REVIEWEDBY--------------------------------------....._.._---------------------- - --- - ---- ---------------------------------- DATE------- BUILDINGPERMIT'ISSUED-------------------------------------- --- ---------- -------------------------------------------- -- DATE---------------------------------------------------- Alterations and/or recommendations:.-.._ ........ -- ---------- ----- � ------------------------------ _ _---- ----------------------------- ------ i -----------'----------------------- ---- :.-.-.-.--- ----------- ---.-.-.----. FINAL INSPECTION BY ___ Date_-_. ._. .._ ' SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 F.Haseltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California I E.H.9 2M 1-67 Vanguard Press