20934 - Laserfiche WebLink

Home Browse Search

FOR OFFICE U-SE: - /a /G APPLICATION FOR, SANITATION PERMIT -----------------"--------- ----------------- Permit No. _ _e_ _.__ ---------- -------------- -------------------------- -- (Complete to Duplicate) o� Date Issued --- -------- -------------------- ------- This Permit Expires 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 co m a�,nce with County Ordinance . 549t ins 6 F s . rsc. '4v �a -'�Q ------°F-••--- - w�`�---------12-Q----------- --------------------- JOB ADDRESS AND L�CjATION_ _E l_bl.�.�R�.,____._ �__-_ _ ___ __ _ _ j'T -- Owner's Name---------------J� u-)_cK------------- CpL�1V Phone._.... Address-----------------8T�•-----r9- ��-----�---------�-lk----------F.-4�------------------------------------------------------------------------------------------------------- Contractor's Name----- O-W-N K-----------------------------------------------------------------------------------------••---------- ---•-------- Phone--------------------------- ------- Installation will serve: Residence [ Apartment House ❑ Commercial ❑ 'Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---I---- Number of bedrooms _3._ Number of baths . Lot size ___/ ..____. `� - ---------------- Water Supply: Public system ❑ Community system ❑ Private ®' Depth to Water Table 91 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..............._---) No Z",New Construction: Yes W-'�o ❑ FHA/VA: Yes �. No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: - -{No septic tank or cesspool permitted-if public sewer is available within 200 feet.) Septic Septic nk: Distance from nearest well__�. 0--- _Distancefrom foundation--- � . .C�aNCaCaRci�t T .-__-__---_. X --------- _No. of compartments_.__-._. —_______ ___Liquid de .th__ __ I _a_ .___ Wa p Y Disposal Field: Distance from nearest well__.-5_ __--Distance fry�. -fo�jn W,ion__--/Q___-__.Distance to nearest lot line___-_-.-.- Number of lines-.-.--------2--------------Length of etch life___-- -- -OF_-- -i .Width of trench.-------�iZ -----.--. ------ I,y' :r Type of filter material__- ©.� K -_Depth of filter material______ --____._Total length__-_---7�l9r�---f ___ Seepage Pit: Distance to nearest well---/0_©--------Distance from foundation____._�0____Distance to nearest lot line---:S__.�__... Number of pits___.._I---_______Lining material__RO<K.----Size: Diameter_Y X_/O__.__-.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------------------------------------------` ❑ Distance to nearest lot line------------------------- --- -------------------------------------------------------- ------------------------------------------------------- 1 Remodelingand/or repairing (describe)------ ----------- ----------------------------------------------------------------------- ------ -----------------•-•----------- ------------------------ fi --------------------------------------- --------------------------I-----------------------.-----------------------------------------------------------------------------------------------------•--------------------------------------------------------------------- -------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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, Od rules and regulations of the San Joaquin Local Health District. il ---------------------------------------- (Owner and/or Contractor (Signed,-------- ---•- - - _ I -------------- y----=----�---r---••-------_----•=;= --._-T- --------------- ------- --------------- -------------- ---------(Tite) - -._._-..,�:- --•.- � (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 APPLICATIONACCEPTED BY--------T - _o-- ------------------------- ----------------•----------------------- DATE--------77_7%---------46------------------- - REVIEWEDBY------------------------------------------------------- ----------------------------- - ------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE-----------------------------------------------------•------- Alterations and/or recommendations:---------------N,0Te___----CH_At4Gr_? -----J.N---------�RQV*------`�`----I-NC-REASE. > L-1=.NG?f•f---------�------4EA-04----41-n-, ----- --rf p----------------- --------------------------- r - ------------- ................................ ------ =--------------- -------------------------------------------------------------------- -------------- --------------------------- FINAL €NSPEC-T1QU__By. l: - Date---------- _ -r-�'- =--------- SAN JOAQUIN LOCAL HEALTH DISTRICT 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.CC.