12295 - Laserfiche WebLink

Home Browse Search

FOR OFFICE U 'E: Permit No. �.z- " �� ,7F APPLICATION FOR SANITATION PERMIT II -----""- ----_. (Complete in Duplica+e] Date issued .- - -------------------- This Permit 1:x fires l Year From Date Issued ------------ - -- Application is hereby made to the San Joaquin Local Health District f49 a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 5 f ------------------------ JOB ADDRESS AND LOCATION_._ ----- phone ---- ------------------------------------------------------------- Owners Name___ ---------------------------------- Address Address----- ---------- --- ----_ - •- �f ��_`_.------ P one -- ,—� t "�L--'`-•!- -- - ----- Motel ❑ Other ❑ Contractor's Name. _.[F2=— Commercial ❑ Trailer Court ❑ Apartment House ❑ __!-___y�•___i'�D.�-------------- r Installation will serve: Residence P Number of living units: _"�_-_ Number of bedrooms /Number of bthh}o"WateoTable _� Nu Private ❑ Dep system Community system ❑ Adobe Hardpan ❑ Water Supply: Public 0. Sand Loam ❑ Clay Loam ❑ Clay ❑ No ❑ Gravel ❑ Y NoFµANA: Yes ❑ Character of soil to a depth of 3 feet: Sand ❑ } Nb-C] New Construction: Yes ❑ Previous Application Made: Jif Yes date__---_-----. _. I TYPE OF INSTALLATION AND SPECIFICATIONS:blic sewer is available within 240.feet.] I - No septic tank or cesspool`permitted if;p - . Capacity-_-------------------- Ta' is Distance from nearest well---------------DjXeance from faundatiLqu�d depth-_Materia_-------,--- ------------' ' -------------•-- O No. of compartments----------•----' �_-._._Distance to nearest lot line_.___ .-----• .ti Width of #ranch_-_.. _rL ------ tell: Distance from nearest,weii._A�.��-Distance from fours anon.__ CIPAQ / Number of lines____ _-�____.------- Length of each line___ ------------ -Total length-- i/ I r �IJ� erial •1 - ` r Gr .� Type of filter{ __ D Stance fotm foun � --Distance to nearest lot line-- .... - V P ., ,.} dation_., -Q= r . f Seepage Pit: Distance to,nearest well_-:___ • 3-`'--- Depth_. o -,---Size:_Diameter_-- . t Lining material._1�4.-- _ _ Number of pits-.-- ' gals. from nearest well:'`-----_---:--•--�4�t#ice from;foundationi- :--------Liquid Capacity------•------------------ Distance ; Cesspool: . TM k ----- P r" ❑ Size: Diameter =:--------•-------•--------------------- 1 Distance from nearest buil ing-- Distance from"nearest well------------- :------- -------" - =-- Privy: ., -•-------••-�-------- ------------•- ❑ Distance to nearest lot line----------------- ------------------ --•-- ---------- - Remodeling and/or repairing (tltescribe): -----------I . . . - „ �•----- •------------- -` ----- -- ------------------ ---------------- -/ = 1 t, _-__ __-_ --• --- ' -•--•---------- ------------------ ------ i ---•---- fa'-•-------•---_ -- -------- -------------•------------••- be ---- - ertif that I have prepared this application and othathe wor Health heDistrtc#n accordance with San Joaquin County i I hereby certify t ordinances. State laws, and rules and regulations of the. q � Contractor) ---•------ Si ned (Title) ----------- - "- ---- By° p� t'a`f�ii� Vi�gf ---- in rel on to wells, buil ngs, etc., can be placed on reverse side). (Plot plan, s98QW9 kiiVrcAvhltr lei s. ys FOR DEPARTMENT USE ONLY tDATE.......... •---- '---�- -------------------- �. APPLICATIONACCEPTED BY ----=------- -----•----- - - ----� -- � �. -------•------------- DATE_.---.....--•-------•-•------------------------------------- REVIEWED ------ ---•-----------•------- ---- - DATE------------------------- ---------------------------------- ---------------------------------- -------- REVIEW ED BY------------------------------------------------------ -------------------------------- ---- t-..- ----- ----------------------�------------------ BUILDING PERMIT ISSUED-------------------------------------- '- {------- ' . -- -- -----••---- --•------------ . -------------- -----------------------•------------•--•-- Alterations and/or recommendations-------------="------'----- '--------�------- -----•-----•�-----------•--••---------- 1 --------------- ------ -- -------------- -----------r''°{� -3--------�---- T/ - �` - _______________________________________T_. Date._.-----`�--'-�- - -0- i FINAL INSPECTION BY:._,��-- :- SAN ^JOAQUIN LOCAL HEALTH DISTRICT :. .. Cyc t 300 West}Oak Street 24 Sycamore Street 205 West 91h Street 130 South American Street Manteca,California Tracy,California Stockton,California Lodi,California E8.9 REVISED e-99 F.R.0 O.21.1 6-6G