20202 - Laserfiche WebLink

Home Browse Search

FOR OFFICE US5: ---F-------- --------- APPLICATION FOR SANITATION PERMITPermit No. ------------- (Complete in Duplicate) Date Issued -e g _____ _----_-------.............. This Permit Expires 1 Year From Date Issued 2_2$^.. 15-0 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein describe_ t. This application,is maderin-com lie a with County Ordinanc No. 549. No_JOB ADDRESS AND LO ATJVN6Phone------------ Owner's Name------------------ ----- = ----------•----•-------------------------•- Address-------•------ --------- ------------•RI-Fo { ` P , Contractor's Name------ TFQ51_/V -- -------- hone-------•- ...... Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ 'Motel I❑ Other ❑ Number of,livingunits: __�__-.Number,of!bed roorris 3_._ Number of baths ._ __-_ Lot size ----04-C 1=1 --------------------- I. Water Supply: Public s stem .r Communit is stem -❑ "Private' Depth to Water Table - ft. Character of soil[to a-depth'af 3 feet:—Sand Gravel Fl-'Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date__-------- f No RT*� New Construction: Yes ❑ No FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: N + (No septic stank or cesspool permitted if public sewer is available,within 200 feet.) -P I Septic Tank: Distance from nearest well'"""""`-Distance from foundation_____--`__ Material_____________________________.______..-__--__ - ❑ No. of compartments------------ ---- -------Size--------------------- -Liqui/d/clepth--------- ----------------Capacity------------ �1&A+�1R`: :+ I / G1 t� Disposal Field: Distance from ;nearest well �_i Distance from foundation__-___ �--_-__.__Distance to nearest lot line`��______ G: V1'4C Number of lines,_____-__-__r_--- ----------------Length of each line_---_. _ ��-.--,-Width of trench__.__.._ _------- -- �� - q ppType offilter material___ O_C.- p -' / g De th of filter mater!ial___- �__ __._Total len th__________________________�. __-- Seepage Pit: rf Distance to nearest well----------------------Distance from foundation---------------------Distance to nearest lot line_---------------" ❑ Number of pitsle ___._...__ Lining material .Bi :.:..Diameter------- ---------------Depth------------------------------ Cesspool: Distance from nearest well-----------------Distance from foundation------------------.Lining material__.__.__.-__------_______-_______. ❑ Size: Diameter-------- .---------------- ------ Depth------------::.- ------------ ----_-Liquid Capacity------ --- ------- E1_. -- gals. Privy: Distance from nearest well__.-___---�--------___l__------------------Distance from nearest building----- G Distance toanearest lot;line. -----_------ '-------------- ------------------------------------ -------------------------- q ❑ .� rvw f.1�3 :��•1 �. Remodeling and/or repairing (describe)=-------APP1T1-0 �'=� ----- x) lM 5 -- - --------------- -------------- --------------------------------------- y, ---------------------------- ------- -------------- -- I +. - - ------------- ------------------------ ----------------------------- ----------------------------------------------------- .---- I hereby certify that I have prepared this application and that the work will lie done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. ~ 0 (Signed) Owner and/or Contractor 's Title iBy:------- - ----- - -- ----------- -------- ( - (Plot plan, showing size of-4o+r crcation of system in relation to'wells, buildings, etc., can be placed on reverse side]. �. FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY--------- '---------------------------------------------------------------- BATE------- --------1s..--- ------- ---------------- REVIEWEDBY----------------------------------------------- --------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED---------------------------------------- --- - -------------------------------- DATE-------------------------------------------- - -------------- Alterations and/or recommendations:.' .�«� -_., _ .-------- -----------•------ ----------------------------------•-- •---_-------------•- ------------------------- --------- 4 .111 qy#s—N----------------------------------------------------------------------------------- --- ------------------------------------------- -- - ----- ------- -------- - ---' 471 FINAL INSPECTI ._ .. - �- - - - - — Date------------- --�--r11?__` ' ------ ---------- --------- SAN JOAQUIN LOCAL HEALTH DISTRICT i x' 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California / F.P.C r]-