15785 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE; t --------------------- -------- -------------------------- ----------------- --------------------------------------- -------------------------____________________________.__._____-__.____.._____-_.- APPLICATION FOR SANITATION PERMIT Permit No. ._.�-�~~��'� ---------------------•---------------------- ------ I (Complete in Duplicate) ' / This Permit Expires 1 Year!From Date Issued Date Issued ...... ��',l ---------- ------- -- --------- --- - ------- q ey Y Application is hereby made to the San Joaquin Local Health District for;ar'permit to constructand install the work herein described. This application is made in compliance with County Ordinance .No. ;549: JOB ADDRESS AND OCATION....._4?,� �_Lf--I G-'Owner's Name Name__..__..__ 1 Q:. ......__ �_ d --------- =---- `---•----•------------- I---------------.Phone..................................... Ra_ Address `' U + = y-•-----'------- .................................. ----------------• Contractor's Name--- r` ..hATJ4QEe4----.._ _ f L!V 1 .T .r Phone................ .................. Installation will serve: Residence [J"Apartment House ❑ Commerelal� ❑ Trailer Court Motel ❑ Other ❑ 4 Number of living units: ._ ---- Number of bedrooms - `-`� :"".f • U �. ;�. f--- Number of maths ./.__ Lot size§ --- -- ................................. Water Supply: Public system ommunity� system ❑ Private ❑ Depth to Water Table _9... ft. { Character of soil to a de th of 3 feet: Sand Gravel Sand. Loam�Cle P t ❑ y y Loam ❑; Clay ❑ Adobe❑ Hardpan Previous Application Made: (If yes,dat---------- No [:1 - New Construction: Yes E] No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: \ C ) -(No-septic tank or-cesspool-permuted-if-public-sewer-is-available-within 200-feet:) Sep}ic Tank: Distance from.nearest well { Qistan from ifound-ahon____ ._____-Material._ 'Q/1f -T •-_, No. of compartments---------t�;Z--------Size__1/_ 90_ 1. Liquid depth-- - _- -----capacity... Disposal Field: Distance from nearest well 0K Distance from `foundation... I 5_.....-- { , Distance to nearest lot line_.._. I _ _ / I - eachline----- Width ofNumof lines � - ------ th of trench.----- ( --r-.- -----` of Typefilter a{ IlC�----- p t ��rTota! length..................�Q-----.-......... Seepage e Pit: Distance well__.!- --•---_____Distance r�m�founda#on_ ________- _ � Distance to nearest lot line--------------c Linin material_______ ______I____-Size: Diameter_.--____----___..__ -. � ❑ Number of pits---�--------------�- 9 . Dept h_.----------------------•------'- Distance from o Ce Cesspool: Distance from nearest weir_______________ Lining material------------------....______.....___ I----- ----------Liquid Capacity- gals. ❑ Size: Diameter----� ..-------� •-------------Qepth----•--------•-------------•- ----------- ------•---------••--••----- Privy: Distance from nearest well---------------------- ---------------------Distance from nearest building___...________..-______-.--•---_:------• ❑ Distance to nearest lot line#------------------------------------------------------------ 1! Remodeling an repairing (describe):-------•---I------------------------------ - •----- ' ..... - �_., -.7=. !. 9 i"'.'... ' L_D19-- '.7r 1 �'�lt3T 1? � � ----- ^�ac F! MtRT. F i-__ F ?U' Tf= �Tr1-`- .-•-= _•_-b�N "�..-_.._.._. ►-I 0-1--------•------------ -. SA ►I1f f lhltt3WAtj a_____ i_ _______ (i ordinances, ---------- ----- =-- --- --•---•---••-----•-------•-----------------------------------------------•----- a licatlon and that the I hereby certify that I have prepared this pp t work will be, done in accordance with San Joaquin County nces, Ste laws nd rules and regulations of the San'J'oaquin'Local`Health District. 1 (Signed).. ....-•------ -,-. ................. •-- .-.---(Owner and/or Contract � •• - - d/o or) Y - —.. '------------ ..: _ ::.::. (Tette}- -------------------------------------------------------- (Plot plan, showing sure of lot, location of system in relation to wells, buildings, e4c.0can be plIced on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ _-'Q� ---------------------------------• ------------------------------ DATE-•--------��-�--=--¢ REVIEWED BY ---------------------- ----------------. DATE ' ----------•------•----- BUILDING PERMIT ISSUED----------------- ........ ------------•-•-•- --•--•-----------••-•-------------- -----.._. QATE�----------------- AFFerations and/or recbritmendations-- ------------------ s -- ------- -~o-- /I(Bhl OlFR 2-10"11 ---------d--- ----d`---�i-----•�---- �t7 �-A, `= ,.1 .._. _7 x.14- ----------•-------------- -----••------- ------------- ------ - --- FINAL INSPECTION .................. -- -- ----- Date-------- .. . SAN JOAQUIN LOCAL HEALTH DISTRICT t 130 South American Street 300 West Oak Street 144 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-99 $M 5-61 ATLAS I i