18359 - Laserfiche WebLink

Home Browse Search

FOR ,* 5E: — w� ----- -- -------- --------- ----------- ---------------- ---------------- ------------------- ---------_________________-.__._.--._I-_.__- APPLICATION FOR SANITATION PERMIT Permit No. —1..j-�-s--,-. ---------------------------------- -------- ------ (Complete in Duplicate} --------------- ------------------ ----------------ql Date issued .-___ „- -- This Permit Expires 1 Year From Date Issued Application is hereby madd!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.An h J013 ADDRESS AND OC" TION____.__ ! _ -.- i [- - Owner's N -- — Ph � -�-z-z _ -- ----------- -------- --- -- ----------------------------- ----------- Address -- one_ ----- ,+ Contractor's Name_____________ µ"" ane - - •� Installation will serve: Residence ❑ Apartment House Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ��.,,// a ,r Number of living units: __�_f___ Number of bedrooms --Lf_. Number of baths �� Lot size _-- �__ a S Water Supply: Public Sys em ( Community system ❑ Private ❑ Depth to Water Table 1r7r ft. Character of soil to a deptS'of 3 feet: Sand h( Gravel ❑ Sandy Loam ❑ Clay Loam p Clay ❑ Adobe ❑ Hardpan F Previous Application Made:: (If yes,date--------------------) No X New Construction: YesX No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION 'AND SPECIFICATIONS: [No septic tank or.,cesspool¢perm'fted,if ublic sewer-is avaailabble_within.200 feet.)- y Septic Tank: Distant dfrom nearest well _.. ---------Qistanc f om i fqundation_ . _ Q Material-------------- ------ ------- c No. of ompartments-____�-______________size ,, /.=-Liquid depth-_._.__ ._- Capacity---Zo �--A I Q I Disposal Field: Distance from nearest well- *j Distance from foundation._`�__ ------Distance to nearest lot�ine_�Q_�_._____ W Number,of lines-----�--. _ _- Length of each line- __"`_Y3!_QI.Width of trench- ,3___.,•------- ---i-•-- r Type offiltermaterials?•-1_ :_Depth of filter mate ria l___/�-----------Total length_________________ r q� Seepage Pit: Distance-.,to nearest well__ ___________________Distance from foundation......•_______.___.Distance to nearest lot line-----0 ❑ Number.lof pits________________ _____Lining --------- Number Diameter_-.____--...___ - ---Depth--- ----------------------------- Cesspool: Distance'f-om nearest well________________ Distance from foundation------------------'Lining material--------_..__._ ❑ Size: D(ameter----- --------------------------------Depth---------_T---- - -- -------------- -----Liquid C -- ::----- ----- - apacity-------------- --------- 9als. 111 t cT __ �s rivy: Distance��rom nearest well------,-----_______--------------------___-----Distance from ,nearesfi building------------------- --- y ❑ Distance fo nearest lot line i i Remodeling and/or repairing describe):_.__At!/ J � t 1 _ i 1_L1f � QCT- -- �----- -- -----r +rl� i? _f�lllti � W 1 T-H _rV.......... l S �`s.---J,.a , ------------------------------ -------------------- ` ------------------•--------------------.---------------------------------------------------------- R ----------------------------------------- - ------ I herebycertify that I have ~ •� y prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St laws apd 'rules' nd r ulations of the Znoaquin Local Health District. ISI (Signed), --- - fir ✓ "'�-� ------(Owner and/or Contractor) -.?.� ) ---------- - ------------ By: _ ------------- (Title) _ -�: (Plot plan, showing size of lot, location of system in relation to we bwldirigs,'etc:, can be placed �reverie-sid#):--.- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ` --- ------- ---- ---- ------- DATE----- REVIEWED BY-----------------------�� -�� - --- ----- ------- --------------------------------------L. DATE--�g-�-f-..----�- -------- ---------------- BUILDING PERMIT ISSUED-:�----------------------------- r -------------------------------------------------------------- ---- DATE-------- Alterations and/or recommendations:____________._.-_-_ . -•--------------------------- --------------- ---!I=------•---------•---- ------- -- ---------------------------------------------------------------------------------------------- ------------------------------------------ ---------------- --•------------- - -•-----. --------------- - 111 - -------------- ----- -------- :-------------------------- -------------- ll Q' FINAL INSPEC ------ Date-------- - -- >r � SAN JOAQUIN LOCAL HEALTH DISTRICT [ 1601 E.Hazelton Ave. I 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi`California Manteca,California Tracy,California F.Ft.0 o.