18341 - Laserfiche WebLink

Home Browse Search

— ` w Y :IN -------------------------- --------_______ APPLICATION FOR SANITATION PERMIT Permit No. __Zj_Slz___ -.-I�------------------------------------------- ---- (Complete in Duplicate) ---- -- --------------------------------- -'- This Permit Expires 1 Year from Date Issued Date Issued F 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 compliance with County Ordinance No. 549. I JOB ADDRESS AND LOCATION_.: ____ ____----_-+1--- ----- S `r Owner's Name--------------09-R.I.._A-- -------- ---=-------------- ------- - '----- -.. Phone--•----- Address------------------ AT _ - ------------•--•-----•-•--- -. �4 . �_ _. ,Contractor's Name------ y�!/�I E:P, --------•--- Phone- ------------------- Installation will serve: Residence .Apartment House ❑ ,Commercial ❑ Trailer Court-❑ Motel ❑ Other E] Number of living units: __I-.__ Num##ber of bedrooms' PPY� y ❑ ComYnunity Sys em [��rivate Ger De+hhto Lot size ---- Water SLipply: Public system Ej comtunity Sys em VV -PD____ ._ __� [�---------------- Water Su ! Public s stem r _ ❑, p Water Table ____ _._ ft_ Character of soil to a depth of 3 feet: Sand Gravel []�Sandy�Loam ❑ �CI�yLoam-❑� Clay E1 --Adobe'❑ Hardpan ❑ I ?� Previous Application Made: (If yes,date.._.__.._ ----- . --1 No �New Construction: Yes E � � FHA/VA: Yes ❑ No TYPE OFINSTALLATIONAND SPECIFICATIONS: m-if T . {No septic tank or cesspool permittedrif public s wer is-available within 20U'"feet;} -�-- Se tic T rfk.. ,At Material-- E .; p� Distance from nearest well_-�_-V -_Dis#anc from foundation i A_-_-_-,�-i0{d�Q� No. of compartrrients____` ___-- -_-Size_-----�_x_�-,�!_Li uid de th �� ' .p - / q P. - - ---Capacity--��O--------- Di sposal;Field: Distance from nearest well_ ._ W Distan r { ndat on __II��_ a 1. Distance to nearest lot line_.______________ Number of lines-.4------- ---------------Len th `c r I Type De ----- Length of filter materia'14__ � V,dth of trench____-=. �i--- ------------- -2-40 in --. - T e of filter material ��'_�•_-_- p fr ��--- -------Total length---------- --- ------------ Seepage'Pit: Distance to nearest well----------------------Distance from foundatiotn "-----------:_.Distance to nearest lot line----------------- f ❑ Dumber 'of --------- ----Lining material------ _---- ---------Size: Ciameter------.---------------- Depth -------- '----- Cesspool: ' Distance from nearest well------------- Distance from foundation- '_�--_.___-----Lining material----._---------- ❑} Size:.Diameter - Depth !-----i ---Liquid Capacity----------------- I ---------gals. _ , Privy: Distance from nearest well------ "--Distan 1exfrom nearest building ' ❑ Distance to nearest lot line. = --------------- --------------------------------------------------------------- r I�emodeling and/or repairing (describe) ----------------------- -- *$,, lt,sR ------------------•-------- -- .------------------------•-----•-------------------------------- -- I ' -- --------------------------I� te`- "n`-- --------- --------- '------------ ! hereb `certify that I have prepard this appl cation 4 --------------------------------'-------------- --- f y y and that the work will be done----------------- m accordance with San Joaquin Count ordinances, Stafe laws, .and rules and Wgulati sof the S Joa uin Lac I Health Dtstrrct..� t`4 + y II I } . (Signed) t ----------� --- __y __ -._h, --------------------------------- -, - - - ._ - er and/or Contractor) :---- .--- .__.--------- - -- --- --- -- - to - ------------------•-;- {Title]""F "�' - =-•----- -. ! (Plot plan, showing size of lot, locationjof system,in relation,fo wells,,build.ings,,etc:, can be placed anireverse side). 11 t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_.__..T .�_V,-- - --------------------------------------------------------- ------ DATE------ 2 t REVIEWED BY ' r - ------ -- '--------- ----------- ----------- ------ - - --- -----'- . DATE----'- - -- ---- ---- �, BUILDING.:PFRMIT.•ISSUED_.z:_-- -- ------------------------------------- -- -- = - —_-=-=•---- ------�DfA'TE. _ Aliferafions"and/or�recomniendattons II° ---"_ --------- --------------- --- ---------7----------- ------------------ ----------------- --- ------ ------------------ ------------------- ------------------ ° -- - ----- --- -------------- ------- ---------- ---- --- -----------' -- ------ - ,:' FINAL INSPECThC-3N�6 =. Date. ---------------------------------------------- SAN -- - ----------- ----------------- SAN JOAQUIN LOCAL HEALTH DISTRICT ' 1601 E.Nozellon Ave. 300 West Oak Street 124 Sycamore Street/ 205 West 9th Street Stockton,California Lodi,California Manteca,Californib . Tracy,California