20836 - Laserfiche WebLink

Home Browse Search

FOR OFFICE USE: _ i . �.. o. - ..//------------ �a ----------------------------- ------------ ------------ APPLICATION FOR SANITATION PERMIT Permit No.':'-Z e ------------------- ----- -------------- -------------- - {Complete in Duplicate) --------------------r -------------- - -------------- --- This Permit Expires 1 Year From Date Issued Date Issued 3 Application is hJreby'madee9 fK6 San Joaquin Local'Healfh-lDisfrict-for-a permit_to construct and install the work herein described. This application made in compliance with County Ordinance 549. JOB ADDRESS A ND OC TION-_ ---,� . 1f - - .h �; Owners Name. { :^ .:_ Phone - --------- s�.� Address----_------ Contrector's Nae,e -----------A. Phone. _0. Q..-y/ Installation will serve: Residence Apartment House ❑ ommercial ❑ Trailer Court ❑I.Motel ❑ Other ❑ _Number jif living units: --- Number of bedrooms.-- Number of the -1--Lot size r Water 5upply:,,•Public system Q Com`mu�nity system ❑ Private Depth to Water Tabled;"ft. Character of.,.soto a depth o'. 3 Sand--_.'E]4 Gravel ❑ Sandy Loam ❑ Clay Loam ❑ "lay- Adobe ardpan ❑ PP I Yes,date..._:_ Previous A Ii Made: I: 'es,all• - - _) No ❑ New Construction: Yes ❑„�.N A/VA: Yes ❑ No ❑ TYPE 'OF INSTALLATION AND SPECIF k, ATIONS. (No septic tank or cesspool permitted if publip sewer is available within 200 feet.) i T Distance from nearesf�well---.---..�..-.--Distance from foundation___._----- _--...'M'aterial"................... % I No. of compartments Size Liq '� dept_ Capacity-------- rsp al ie! Distance from near st well ..: ...Distance from foundation. ... ...--------DistanCie to neares lot line-_ Number of;I,ines_..�--- -- ----- ----- - - - Length of each line.....___ .f-----_.Width of trench if �i Type of filt6r•'materr -Depth of filter material-_.�" l� 'Total lengt �- -' Seee ftti�N: Distance to Weare well distance rom f undationf !Distance.to.nearest lot line..... SSW..,, -Number of pits------ ---------------Lini g material-- _o- Size: Diameter__,-� 4 t - �--x�---Depth----�� ------------- Cesspool: Distance from nearest well-------------- Distance fro oundation--...-..-______'-_ in4 nia erial--------------------------------------- -Capacity -----_ - 5vie'r Diametet`r---- - ------------ --- - -- --- Depth -' Liquid-Capacity---------------------------gals. Priv stance Distance from nearest wel! _____.---_-_ ._ -----------Distance from nearest,buildin Q : Distance to nearest lof*line•__...._-"___-. 10, - ----------------- -----•------ --------------- --------------------------------- Remo deiing and/or repairing J(describe) ?-------- __ ----------- --------=- ----- -- . -- ------------------------------------------------------------------------------- -- -------- ------- -j'� ---------------------- F ------ --------------------:------------------------- ------------------------------ I hereby c y t t I h e preparFe�d this ap I cation an at the work ill be done in 1or_dance with San Joaquin County , ordinances, a rules n r lotions of e a a in Loc" ea stilt+, p (Signe - ----------- ---- -------- ----- o x- ontractar) By:- ------------�-T •----- --- -------/ - :_. � , :- + le ------ -------- -------- -------- - (Plot plan, showing sae of ot, location of system in relation + we , bui zings, etc., c be placed on reverse side). FOR DEPA TMENT USE ONLt, APPLICATION ACCEPTED BY--.Z�. ------------------------------------------------------------------ --------- DATE---- REVIEWEDBY------------------------------------- - --- --"- ------------------ ------ ------- DATE---- -------------------------------------- BUILDING PERMIT ISSUED---------- ----------------------- ---------------- ;----- DATE - ------------------------------------------ --------------------------------------------------- __v--------------------------------------------------------- ------------- and/or recommendations:--- 7+�'j °�------------------------------ ----------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------- ��`k - G= -------------------------------------- -------------- ------ ----- --- - ----------------------------------------- --------------------------------------------------- ---------_---- --- ------------------------- ----------I-------------------------------------------------------------- FINAL INSPECTION BY:-...-, ------------------------- Date _ SAN JOAQUIN LOCAL HEALTH DISTRICT 4 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.C q.