19496 - Laserfiche WebLink

Home Browse Search

rUKUrr�Cr U��r_: t q2� -- -- ------- --- ----------------------------------- - ------ ------------------------------------------------ ------------------------------------------------------------------------------------------ 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 Sin Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No549r. �a ot� r&G -- 4 -------------- JOB ADDRESS AN�DLOCTiON---- ---------- ------- - Owner's Nam _-._-_.-_ N -- ---- l A--------01-�-=--- �Tf��1 ©l� ��f �7-�.__ U Zo-0� p P'0_43( `Phone------_----•-------------------•- Address__..Q... t ' ------- ---------1V-a_yVMAW_,_-- :,--k1_E'---------------------------------------- Contractor'sName .-141-L � ---------------------------------_ Phone-------------------------------- C Installation will serve: Residence El Apartment House [-] Commercial Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __ Number of bedrooms -------- Number of baths P__ Lot size ---1.3.0...><______L;;�p_-_._____.____ n Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand @T' Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No UT-"-New Construction: Yes 531"No ❑ FHA/VA: Yes ❑ No TYPE_ OF INSTALLATION AND SPECIFICATIONS: _ ' (No septic tank or cesspool permitted if public sewer is available within 200 feet.) , _ Qi Septic Tank: Distance from nearest well_____�0____Disfa e from foundation___119--------- Materi <0gCR_E._rF_=------------ No. of compartments_____.___� _______Size_ x_i_s x.__ ___LI uid de th___.f _'Fz Capacity JQQf . _ Disposal Field: Distance from nearest well...5-0....Distance from foundation-----ID........Distance to nearest lot line------ It Number of lines___-__--__ u �..__.___________Length of each line_/Q!4!!J6_0__.___Width of french------ _. �1 �_ � _ f,Type of filter material___130<Q K.__Depth of filter material----1_q._____ __..Total length____-- -.______..___� Seepage Pit: Distance to nearest weft-------_--------------Distance from foundation--------------------Distance to nearest lot line__.__.__-_.___.._ ❑ Number of Pits----------------------Lining material----------.------------Size: Diameter-----------------------Depth-------------------------__------ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-----------.____._._____.____________ ❑ Size: Diameter--------------------------------------Depth-------------------------------------------- -------Liquid Capacity-- .---------------------gals. Privy: Distance from nearest well---------------.---------------------------------Distance from nearest building____________r_____________________________ ❑ Distance to nearest lot line--------------------------------------------- ------------------------------------------------ --------------------------------------------- Remodeling and/or repairing (describe):-- ----------------- -------------- - ------------- -----• ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------- . 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 5a Joaqui Local Health District. (Signed)---- ------ 6-- ----- ------ ---"------(------ -- ----------------------------------------------------------)Owner and/or Contractor) - T. It (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ t _jR_J9�-------------------------------------------------------------------- --- —...��` DATE REVIEWEDBY----- ------------------------------------ - ------------------------------------- DATE------ ------- --------------------------------------------- -- - -- - -------------------------------------- -- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE. Alterations and/or recommendations:__._.5�=___1F -----�Cff_AAj,1&.A ---------5D40 i!_Nf-------[ --- ------------ f C/'�-r----------------------- ---------------------------------------------------------------------------- - ----- �"!_R_°0_ FINAL INSPE Date-- f ��?_ l SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street { 5locklon,California Lodi,California Manteca,California Tracy,California F.P.E o.